ASD 100 Days Kit

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Autism Speaks does not provide medical or legal advice or services. Rather, Autism Speaks
provides general information about autism as a service to the community. The information
provided in this kit is not a recommendation, referral or endorsement of any resource, therapeutic
method, or service provider and does not replace the advice of medical, legal or educational
professionals. This kit is not intended as a tool for verifying the credentials, qualifications, or
abilities of any organization, product or professional. Autism Speaks has not validated and is not
responsible for any information or services provided by third parties. You are urged to use
independent judgment and request references when considering any resource associated with
the provision of services related to autism
©2010 Autism Speaks Inc. Autism Speaks and Autism Speaks It’s Time To Listen & Design are trademarks owned by Autism Speaks Inc. All rights reserved.
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Chief Administrative Officer, The Marcus Autism Center
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Strong Center for Developmental Disabilities
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Executive Director, Autism New Jersey
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Yale University, School of Medicine
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Vanderbilt Kennedy Center
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Why was my child diagnosed with Autism? And what does it mean?......................Page 1
Why does my child need a diagnosis of Autism?................................................Pages 1-2
How is Autism Diagnosed?.................................................................................Pages 2-3
What is Autism?.......................................................................................................Page 3
DSM-IV Criteria for Autism Diagnosis......................................................................Page 4
How Common is Autism? What Causes Autism?....................................................Page 5
More Information about the Symptoms of Autism...............................................Pages 6-8
Unique Abilities that May Accompany Autism .. ..Pages 9-10
Physical and Medical Issues that May Accompany Autism . ..Pages 11-13
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How Will I Deal with the diagnosis?................................................................Pages 14-15
Caring for the Caregiver..................................................................................Pages 16-19
What Should We Know about our Younger and Future Children?..................Pages 20-21
How Will this Affect our Family?.............................................................................Page 21
Sharing Your Struggle............................................................................................Page 22
Fifteen Tips for your Family.............................................................................Pages 23-25
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How Do I Get the Help My Child Needs?...............................................................Page 26
Accessing Services: Your Child’s Rights ............................Pages 27-28
Early Intervention Services ..Page 29
Special Education Services ... ..Pages 29-30
How Do I Get Services Started for My Child?.................................................Pages 30-31
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How is Autism Treated?..................................................................................Pages 32-33
Treatments for Core Symptoms ..................................................................Page 34
Applied Behavioral Analysis (ABA).................................................................Pages 35-36
Pivotal Response Treatment (PRT)................................................................Pages 36-37
Verbal Behavior (VB).......................................................................................Pages 37-38
Early Start Denver Model . Pages 38-39
Floortime (DIR)................................................................................................Pages 39-40
Relationship Development Intervention (RDI).................................................Pages 41-42
Training & Education of Autistic & Related Communication Handicapped Children
(TEACCH) ..Page 42
Social Communication/Emotional Regulation/Transactional Support (SCERTS)..Page 43
Treatment for Associated, Medical & Biological Symptoms and Other Medical
Interventions ...Pages 44-46
Is There A Cure?....................................................................................................Page 47
How Do I Choose the Right Intervention?.......................................................Pages 47-48
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Assembling/Managing Your Team..................................................................Pages 49-51
Ten Things Every Child with Autism Wishes You Knew Pages 52-54
Suggested Books & Websites.........................................................................Pages 55-58
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Ask for Help! Contact the Autism Response Team (ART). Our ART team
members are specially trained to help families with the day-to-day challenges of
living with autism. Contact ART for resources, support and information.
Call us at 888-AUTISM 2 (288-4762) or email familyservices@autismspeaks.org.
More information... There is a wealth of information on the Autism Speaks web site.
Visit www.AutismSpeaks.org
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Your child has been diagnosed with autism or autism spectrum disorder and you
have asked for help. This is an important turning point in a long journey. For
some families, it may be the point when, after a long search for answers, you
now have a name for something you didn’t know what to call, but you knew existed.
Perhaps you suspected autism, but held out hope that an evaluation would prove
otherwise. Many families report mixed feelings of sadness and relief when their child is
diagnosed. You may feel completely overwhelmed. You may also feel relieved to know
that the concerns you have had for your child are valid. Whatever it is you feel, know that
thousands of parents share this journey. You are not alone. There is reason to hope.
There is help. Now that you have the diagnosis, the question is, where do you go from
here? This handbook, the Autism Speaks™ 100 Day Kit, was created to help you make
the best possible use of the next 100 days in the life of your child. It contains information
and advice collected from trusted and respected experts on autism and parents like you.
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Parents are usually the first to notice the early signs of autism. You probably
noticed that your child was developing differently from his or her peers. The
differences may have existed from birth, or may have become more noticeable later.
Sometimes the differences are severe and obvious to everyone. In other cases, they are
more subtle and are first recognized by a day-care provider or preschool teacher. Those
differences, the symptoms of autism, have led thousands of parents like you to seek
answers that have resulted in a diagnosis of autism. You may wonder: Why does my
child need a diagnosis of autism? That’s a fair question to ask - especially when right
now, no one is able to offer you a cure.
Autism Speaks is dedicated to funding global biomedical research to find the causes and
a cure, along with effective prevention and treatment methods. Great strides have been
made and the current state of progress is a far cry from the time when parents were
given no hope for their children. Some of the most brilliant minds of our time have turned
their attention toward this disorder, and we are working at a constantly increasing pace
toward a cure for autism. While we live in an age of miracles and wonders, we’re not
there yet. In the meantime, the best treatments available to us now – the therapies and
interventions you will learn about in this handbook – are our chemotherapy, our dialysis,
our insulin.
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There are however, several reasons having a diagnosis is important for your child. A
thorough and detailed diagnosis provides important information about your child’s
behavior and development. It can help create a road map for treatment, by identifying
your child’s specific strengths and challenges and providing useful information about
which needs and skills should be targeted for effective intervention. A diagnosis is often
required to access autism specific services through early intervention programs or your
local school district.
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Presently, there is not a medical test for autism; a diagnosis is based on
observed behavior and educational and psychological testing. As the symptoms
of autism vary, so do the routes to obtaining a diagnosis. You may have raised
questions with your pediatrician. Some children are identified as having developmental
delays before obtaining a diagnosis of autism and may already receive some Early
Intervention or Special Education services. Unfortunately, parents’ concerns are
sometimes not taken seriously by their doctor and as a result, a diagnosis is delayed.
Autism Speaks and other autism related organizations are working hard to educate
parents and physicians, so that children with autism are identified as early as possible.
From birth to at least 36 months of age, every child should be screened for
developmental milestones during routine visits. The American Academy of Pediatrics
recommends that all children be screened for autism at their 18- and 24-month well-baby
check-ups. If concerns about a child’s development are raised, his or her doctor should
refer the child to Early Intervention and a specialist for a developmental evaluation.
Hearing and lead exposure screenings should be performed and an autism-specific
screening tool, such as the Modified Checklist of Autism in Toddlers (MCHAT),
should be used. (http://www.dbpeds.org/media/mchat.pdf)
The MCHAT is a list of simple questions about your child. The answers determine
whether he or she should be referred to a specialist, usually a Developmental
Pediatrician, a Neurologist, a Psychiatrist or a Psychologist, for further evaluation.
There are other screening tools available, some geared towards older children or
specific Autism Spectrum Disorders. Your child may have been diagnosed by one of
the professionals mentioned above. In some cases, a team of specialists may have
evaluated your child and provided recommendations for treatment. The team
may have included an Audiologist, to rule out hearing loss, a Speech & Language
Therapist, to determine language skills and needs, and an Occupational Therapist to
evaluate physical and motor skills. A multi-disciplinary evaluation is important for
diagnosing autism and other challenges that often accompany autism, such as delays in
motor skills. If your child has not been evaluated by a multi-disciplinary team, you will
want to make sure further evaluations are conducted so that you can learn as much as
possible about your child’s individual strengths and needs. For more information you can
visit The Autism Treatment Network at: www.autismspeaks.org/science/programs/atn/
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Autism is a general term used to describe a group of complex developmental
brain disorders known as Pervasive Developmental Disorders (PDD). The
other pervasive developmental disorders are PDD-NOS (Pervasive
Developmental Disorder – Not Otherwise Specified), Asperger Syndrome, Rett
Syndrome and Childhood Disintegrative Disorder. Many parents and professionals
refer to this group as Autism Spectrum Disorders.
You may also hear the terms Classic Autism or Kanner’s Autism (named after the first
psychiatrist to describe autism) used to describe the most severe form of the disorder.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental
Disorders is the main diagnostic reference used by mental health professionals and
insurance providers in the United States. The current (fourth) edition, which was
published in 1994, is commonly referred to as the “DSM-IV.” The diagnosis of autism
requires that at least six developmental and behavioral characteristics are observed, that
problems are present before the age of three, and that there is no evidence for certain
other conditions that are similar. The DSM-IV is currently being revised. The DSM-V
will group together the subtypes of autistic disorder, PDD-NOS, and Asperger Syndrome
under the umbrella term “Autism Spectrum Disorder” because research has not shown
these categories to be distinct. Rather, they are part of a broad continuum of disorders
that involve difficulties in social and communication skills.
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Today, it is estimated that one in every 110 children is diagnosed with autism in
the United States, making it more common than childhood cancer, juvenile
diabetes and pediatric AIDS combined. An estimated 1.5 million individuals in the
United States and tens of millions worldwide are affected by autism. Government
statistics suggest the prevalence rate of autism is increasing 10-17 percent annually.
There is no established explanation for this increase, although improved diagnostic
methods and environmental influences are two reasons often considered. Studies
suggest boys are more likely than girls to develop autism and receive the diagnosis
three to four times more frequently. Current estimates are that in the United States
alone, one out of 70 boys is diagnosed with autism.
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It is important to keep in mind that autism is not one disorder with one cause.
Rather, it is a group of related disorders with many different causes. In most
instances, autism is likely caused by a combination of genetic risk factors that interact
with environmental risk factors. Several autism susceptibility genes have been
identified, meaning that an individual will be more likely to develop autism if they have a
specific variant of this gene, or in some cases, a rare mutation in the gene. Many genes
likely contribute to autism. These specific genes are believed to interact with certain
environmental factors. A great deal of research is currently focused on identifying how
both genetic and environmental risk factors contribute to autism. Although some genetic
factors have been identified, less is known about the specific environmental factors that
contribute to autism. Exposure to environmental agents such as infectious agents
(maternal rubella or cytomegalovirus) or chemical agents (thalidomide or valproate)
during pregnancy can cause autism. About 10-15% of cases have a specific, identifiable
genetic cause, such as such as Fragile X Syndrome, Tuberous Sclerosis, and
Angelman’s Syndrome.
There is a growing interest among researchers about the role of the function and
regulation of the immune system, both within the body and the brain, in autism.
Piecemeal evidence over the past 30 years suggests that people with autism may
experience inflammation in the central nervous system. There is also emerging evidence
from animal studies that illustrates how the immune system can influence behaviors
related to autism. Autism Speaks is working to extend awareness and investigation of
potential immunological issues to researchers outside the field of autism as well as those
within the autism research community.
While the causes of autism are complex, it is clear that it is not caused by bad parenting.
Dr. Leo Kanner, the psychiatrist who first described autism as a unique condition in
1943, believed that it was caused by cold, unloving mothers. Bruno Bettelheim, a
renowned professor of child development perpetuated this misinterpretation of autism.
Their promotion of the idea that unloving mothers caused their children’s autism created
a generation of parents who carried the tremendous burden of guilt for their children’s
disability. In the 1960s and 70s, Dr. Bernard Rimland, the father of a son with autism,
who later founded the Autism Society of America and the Autism Research Institute,
helped the medical community understand that autism is a biological disorder, and is not
caused by cold parents.
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Autism affects the way your child perceives the world and makes communication
and social interaction difficult. He may also have repetitive behaviors or intense
interests. Symptoms and their severity are different for each child in each of the
affected areas (Communication, Social Interaction, and Repetitive Behaviors). Your child
may not have the same symptoms and may seem very different from another child with
the same diagnosis.
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Although autism is usually a life-long condition, the symptoms of autism can change over
time. The long term outcome is highly variable. Some children lose their diagnosis over
time, while others remain severely affected. Many have normal cognitive skills, despite
challenges in social and language abilities. Most individuals with autism develop speech
and learn to communicate with others. Early intervention can make extraordinary
differences in your child’s development. How your child is functioning now may be very
different from how he or she will function later on in life.
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From the start, typically developing infants are social beings. Early in life, they gaze
at people, turn toward voices, grasp a finger and smile. By contrast, many children
with autism have difficulty learning to engage in the give-and-take of everyday human
interactions. Even in the first year of life, many may prefer playing with objects and may
fail to initiate social interaction or engage in communicative babbling and imitative play.
Eye contact may be fleeting. Most have difficulty using gestures such as pointing,
waving bye-bye, and showing objects to others. Research has suggested that although
children with autism are attached to their parents, their expression of this attachment is
unusual and difficult to “read”. To parents, it may seem as if their child is not connected
at all.
Children with autism are also slower in learning to interpret what others are thinking and
feeling. Subtle social cues such as a smile, a wave, or a grimace may have little
meaning to a child with autism. To a child who misses these cues, “Come here” may
always mean the same thing, whether the speaker is smiling and extending her arms for
a hug, or frowning and planting her fists on her hips. Without the ability to interpret
gestures and facial expressions, the social world may seem bewildering. To compound
the problem, people with autism have difficulty seeing things from another person’s
perspective. Most five-year-olds understand that other people have thoughts, feelings,
and goals that are different from their own. A child with autism may lack such
understanding. This inability leaves them unable to predict or understand other people’s
actions.
Although not universal, it is common for people with autism to have difficulty regulating
their emotions. This can take the form of “immature” behavior such as crying in class, or
verbal outbursts that seem inappropriate to those around them. Sometimes they may be
disruptive and physically aggressive, making social relationships even more difficult.
They have a tendency to “lose control”, particularly when they’re in a strange or
overwhelming environment, or when they are angry or frustrated. At times, they may
break things, attack others, or hurt themselves. In their frustration, some bang their
heads, pull their hair or bite their arms.
Fortunately, children with autism can be taught how to socially interact, use gestures,
and recognize facial expressions. Also, there are many strategies that can be used to
help the child with autism deal with frustration so that they don’t have to resort to
challenging behaviors. We will discuss this later.
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By age three, most children have passed predictable milestones on the path to
learning language; one of the earliest is babbling. By the first birthday, a typical
toddler says a word or two, turns and looks when he hears his name, points when he
wants a toy, and when offered something distasteful, makes it clear that the answer is
“no”. Although a minority of people with autism doesn’t use speech, the large majority
develops spoken language, and all eventually learn to communicate in some way. Most
infants who later show signs of autism “coo” and babble during the first few months of
life, but over time, they stop. Others may be delayed, developing language as late as
age five to nine. Some children may learn to use communication systems such as
pictures or sign language. Children with autism who do speak often use language in
unusual ways. They seem unable to combine words into meaningful sentences. Some
speak only single words, while others repeat the same phrase over and over. They may
repeat or “parrot” what they hear, a condition called echolalia. Although many children
with autism go through a stage where they repeat what they hear, it normally passes by
the time they turn three. Some children with autism who are only mildly affected may
exhibit slight delays in language, or even seem to have precocious language and
unusually large vocabularies, but still have great difficulty in sustaining a conversation.
The “give and take” of normal conversations may be hard, but they may often carry on a
monologue on a favorite subject, giving others little opportunity to comment. Another
common difficulty is the inability to understand body language, tone of voice, or “phrases
of speech.” For example, someone with autism might interpret a sarcastic expression
such as “Oh, that’s just great” as meaning it really IS great. It can be challenging
sometimes for others to understand what children with autism are saying, as well as
what their body language means. Facial expressions, movements, and gestures may not
match what they are saying. Also their tone of voice may fail to reflect their feelings.
They may use a high-pitched, sing-song, or flat, robot-like voice. Some children with
relatively good language skills speak like little adults, failing to pick up on the “kid-speak”
that is common in their peers. Without meaningful gestures or the language to ask for
things, people with autism have difficulty letting others know what they need. As a result,
they may simply scream or grab what they want. Fortunately, children with autism can
be taught to communicate in more appropriate way.
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Although children with autism usually appear physically normal, odd repetitive
motions may set them apart from other children. These behaviors might be extreme
and highly apparent or more subtle. Some children and older individuals with autism
repeatedly flap their arms or walk on their toes. Some suddenly freeze in a position. As
children, individuals with autism might spend hours lining up their cars and trains in a
certain way, rather than using them for pretend play. If someone moves one of the toys,
the children may become tremendously upset. Many children with autism need and
demand absolute consistency in their environment. A slight change in routines, such as
eating a meal, getting dressed, taking a bath, and going to school at a certain time or by
the same route, can be extremely stressful. Repetitive behavior sometimes takes the
form of a persistent, intense preoccupation. These strong interests may be unusual
because of their content (e.g. fans or toilets) or because of the intensity of the interest
(e.g. extremely detailed information about Thomas the Tank Engine). For example, a
child with autism might be obsessed with learning all about vacuum cleaners, train
schedules, or lighthouses. Often older children with autism have a great interest in
numbers/ letters, symbols, dates or science topics.
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Along with the challenges that autism involves, you may have noticed that your
child also exhibits areas of strength. Although not all children have special
talents, it is not uncommon for individuals with autism to have exceptional skills in
math, music, art, and reading, among others. These areas of expertise can provide
great satisfaction and pride for the child with autism. If possible, incorporate your child’s
areas of expertise into his everyday activities and use them whenever possible as a way
for he or she to learn and excel.
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Seizure Disorder, also called Epilepsy, occurs in as many as 39% of people with
autism. It is more common in children who also have cognitive deficits than those
who do not. Some researchers have suggested that seizure disorder is more common
when the child has shown a regression or loss of skills. There are different types and
subtypes of seizures and a child with autism may experience more than one type. The
easiest to recognize are large “grand mal” (or tonic-clonic) seizures. Others include
“petit mal” (or absence) seizures and subclinical seizures, which may only be
apparent in an EEG (Electroencephalogram). It is not clear whether subclinical
seizures have effects on language, cognition, and behavior. The seizures associated
with autism usually start either early in childhood or during adolescence, but may occur
at any time. If you are concerned that your child may be having seizures you should see
a neurologist. The neurologist may order tests which may include an EEG, an MRI
(Magnetic Resonance Imaging), CT (Computed Axial Tomography) and a CBC
(Complete Blood Count). Children and adults with epilepsy are typically treated with
anticonvulsant or seizure medicines to reduce or eliminate occurrence. If your child has
epilepsy, you will work closely with a neurologist to find the medicine that works the best
with the fewest side effects, and to learn the best ways to ensure your child’s safety
during a seizure.
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About 10-15% of children with autism have an identifiable neurogenetic condition
such as Fragile X Syndrome, Angelman’s Syndrome, a neurocutaneous
disorder called Tuberous Sclerosis, Chromosome 15 Duplication Syndrome or other
chromosomal abnormalities. If your child has clinical features, such as a family history
or physical symptoms, that are characteristic of one of these disorders, your pediatrician
may order tests or may refer you to a developmental pediatrician, a geneticist and/or a
child neurologist for testing. The chance of having one of these abnormalities is slightly
higher if your child also has cognitive deficits or mental retardation. It is also higher if
your child has certain physical features that are characteristic of a given syndrome.
While none of these conditions is curable, it is important to know if your child has one of
these syndromes as there may be other medical issues that go along with some of them.
Having a known genetic cause for autism may also change your risk of having another
child with autism.
11
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Many parents report gastrointestinal (GI) problems in their children with autism.
The exact prevalence of gastrointestinal problems, such as gastritis, chronic
constipation, colitis, and esophagitis in individuals with autism is unknown. Surveys
have suggested that between 46 and 85% of children with autism have problems such
as chronic constipation or diarrhea. One study identified a history of gastrointestinal
symptoms (such as abnormal pattern of bowel movements, frequent constipation,
frequent vomiting, and frequent abdominal pain) in 70% of the children with autism. If
your child has symptoms such as chronic or recurrent abdominal pain, vomiting,
diarrhea, or constipation, you will want to consult a gastroenterologist (preferably one
that works with people with autism). Your child’s physician may be able to help you find
an appropriate specialist. Pain caused by GI issues is sometimes recognized because of
a change in a child’s behavior, such as an increase in self-soothing behaviors like
rocking, or outbursts of aggression or self-injury. Bear in mind that your child may not
have the language skills to communicate the pain caused by GI issues. Treating GI
problems may result in improvement in your child’s behavior. Anecdotal evidence
suggests that some children may be helped by dietary intervention for GI issues,
including the elimination of dairy and gluten containing foods. (For more information, see
Gluten Free Casein Free diet in the treatment section of this kit). As with any treatment,
it is best to consult your child’s physician to develop a comprehensive plan. In January
2010, Autism Speaks initiated a campaign to inform pediatricians about the diagnosis
and treatment of GI problems associated with autism.
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Is your child having trouble getting to sleep or sleeping through the night? Sleep
problems are common in children and adolescents with autism. Having a child with
sleep problems can affect the whole family. It can also have an impact on the ability of
your child to benefit from therapy. Sometimes sleep issues may be caused by medical
issues such as obstructive sleep apnea or gastroesophageal reflux, and addressing
the medical issues may solve the problem. In other cases, when there is no medical
cause, sleep issues may be managed with behavioral interventions including “sleep-
hygiene” measures, such as limiting the amount of sleep during the day, and
establishing regular bedtime routines. There is some evidence of abnormality of
melatonin regulation in children with autism. While melatonin may be effective for
improving the ability of children with autism to fall asleep, more research is needed.
Melatonin or sleep aids of any kind should not be given without first consulting with your
child’s physician.
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Many children with autism experience unusual responses to sensory stimuli, or
input. These responses are due to difficulty in processing and integrating sensory
information. Vision, hearing, touch, smell, taste, the sense of movement (vestibular
12
system) and the sense of position (proprioception) can all be affected. This means that
while information is sensed normally, it may be perceived much differently. Sometimes
stimuli that seem “normal” to others can be experienced as painful, unpleasant or
confusing by the child with Sensory Integration Dysfunction (SID), the clinical term for
this characteristic. (SID may also be called Sensory Processing Disorder or Sensory
Integration Disorder.) SIDs can involve hypersensitivity, also known as sensory
defensiveness, or hyposensitivity. An example of hypersensitivity would be an inability
to tolerate wearing clothing, being touched, or being in a room with normal lighting.
Hyposensitivity might be apparent in a child’s increased tolerance for pain or a constant
need for sensory stimulation. Treatment for Sensory Integration Dysfunction is usually
addressed with occupational therapy and/or sensory integration therapy.
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Pica is an eating disorder involving eating things that are not food. Children
between 18 and 24 months old often eat non food items, but this is typically a
normal part of development. Some children with autism and other developmental
disabilities persist beyond the developmentally typical time frame and continue to eat
items such as dirt, clay, chalk or paint chips. Children showing signs of persistent
mouthing of fingers or objects, including toys, should be tested for elevated blood levels
of lead, especially if there is a known potential for environmental exposure to lead.
13
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You are never prepared for a diagnosis of autism. It is likely that you will
experience a range of emotions. It is painful to love so much, to want something
so much, and not quite get it. You want your child to get better so much you may
feel some of the stages commonly associated with grieving. You may “revisit” these
feelings from time to time in the future. Part of moving forward, is dealing with your own
needs and emotions along the way.
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Elisabeth Kübler-Ross outlined five stages in the grief process. Grief does not
progress in an orderly way that follows a predictable path. It is normal to move
forwards and backwards among the five stages; skip a stage or be stuck in one.
Her five stages are outlined below.
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Immediately after the diagnosis you may feel stunned or confused. The reality of the
diagnosis may be so overwhelming that you’re not ready to accept it or you initially
ignore it. You may also question the diagnosis, or search for another doctor who will tell
you something different.
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Many parents must mourn the loss of some of the hopes and dreams they had for
their child before they can move on. There will probably be many times when you
feel extremely sad. Friends may refer to this as being “depressed,” which can sound
frightening. There is, however, a difference between sadness and depression.
Depression often stands in the way of moving forward. Allowing yourself to feel sadness
can help you grow. You have every right to feel sad and to express it in ways that are
comfortable. Crying can help release some of the tension that builds up when you try to
hold in sadness. A good cry can get you over one hurdle and help you face the next. If
you find that your sadness is interfering with your ability to cope, or you show other
symptoms of depression, such as weight loss, social withdrawal, suicidal thoughts, sleep
difficulties, low self-esteem, loss of interest in daily activities, consult your family
physician who can recommend treatment.
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With time, your sadness may give way to anger. Although anger is a natural part of
the process, you may find that it’s directed at those closest to you – your child, your
spouse, your friend or at the world in general. You may also feel resentment toward
parents of typical children. Your anger may come out in different ways – snapping at
people, overreacting to small things, even screaming and yelling. Anger is normal. It is a
healthy and expected reaction to feelings of loss and stress that come with this
diagnosis. Expressing your anger releases tension. It is an attempt to tell the people
around you that you hurt, and that you are outraged that this diagnosis has happened to
your child.
14
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You may go through periods of refusing to believe what is happening to your child.
You don’t consciously choose this reaction; like anger, it just happens. During this
time, you may not be able to hear the facts as they relate to your child’s diagnosis. Don’t
be critical of yourself for reacting this way. Denial is a way of coping. It may be what gets
you through a particularly difficult period. You must, however, be aware that you are in
denial, so that it doesn’t cause you to lose focus on your child’s treatment. Try not to
“shoot the messenger.” When someone, a professional, a therapist or a teacher, tells
you something that is hard to hear about your child, consider that they are trying to help
you so that you can address the problem. It is important not to alienate people who can
give you helpful feedback and help monitor your child’s progress. Whether you agree or
not, try to thank them for the information. If you are upset, try considering their
information when you have had a chance to calm down.
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You may feel isolated and lonely. These feelings may have many causes.
Loneliness may also come from the fact that in your new situation, you simply don’t
feel like you have the time to contact friends or family for company. You may feel that if
you did reach out, they wouldn’t understand or be supportive. In the pages that follow,
we have some suggestions for taking care of yourself and for getting the support you
need.
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Ultimately, you may feel a sense of acceptance. It’s helpful to distinguish between
accepting that your child has been diagnosed with autism and accepting autism.
Accepting the diagnosis simply means that you are ready to advocate for your child. The
period following an autism diagnosis can be very challenging, even for the most
harmonious families. Although the child with autism may never experience the negative
emotions associated with the diagnosis, parents, siblings and extended family members
may each process the diagnosis in different ways, and at different rates. Give yourself
time to adjust. Be patient with yourself. It will take some time to understand your child’s
disorder and the impact it has on you and your family. Difficult emotions may resurface
from time to time. There may be times when you feel helpless and angry that autism has
resulted in a life that is much different than you had planned. But you will also
experience feelings of hope as your child begins to make progress.
15
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Changing the course of the life of your child with autism can be a very rewarding
experience. You are making an enormous difference in his or her life. To make it
happen, you need to take care of yourself. Take a moment to answer these
questions: Where does your support and strength come from? How are you really
doing? Do you need to cry? Complain? Scream? Would you like some help but don’t
know who to ask?
Z*,*,-*.#$%0$#&4#B5+#;0"$#$5#$0(*#$%*#-*'$#95''&-/*#=0.*#54#B5+.#=%&/:)#B5+#,+'$#
4&.'$#$0(*#$%*#-*'$#95''&-/*#=0.*#54#B5+.'*/4C#
Parents often fail to evaluate their own sources of strength, coping skills, or emotional
attitudes. You may be so busy meeting the needs of your child that you don’t allow
yourself time to relax, cry, or simply think. You may wait until you are so exhausted or
stressed out that you can barely carry on before you consider your own needs. Reaching
this point is bad for you and for your family. You may feel that your child needs you right
now, more than ever. Your “to do” list may be what is driving you forward right now. You
may feel completely overwhelmed and not know where to start. There is no single way to
cope. Each family is unique and deals with stressful situations differently. Getting your
child started in treatment will help you feel better. Acknowledging the emotional impact
of autism and taking care of yourself during this stressful period will help prepare you for
the challenges ahead. Autism is a pervasive, multi-faceted disorder. It will not only
change the way that you look at your child, it will change the way you look at the world.
As some parents may tell you, you may be a better person for it. The love and hope that
you have for your child is probably stronger than you realize.
O*.*#0.*#'5,*#$&9'#4.5,#90.*"$'#;%5#%07*#*P9*.&*"=*:#;%0$#B5+#0.*#>5&">#
$%.5+>%T#
Get going. Getting your child started in treatment will help. There are many details
you will be managing in an intensive treatment program, especially if it is based in
your home. If you know your child is engaged in meaningful activities, you will be more
able to focus on moving forward. It may also free up some of your time so you can
educate yourself, advocate for your child, and take care of yourself.
Ask for help. Asking for help can be very difficult, especially at first. Don’t hesitate to
use whatever support is available to you. People around you may want to help, but
may not know how. Is there someone who can take your other kids somewhere for an
afternoon? Or cook dinner for your family one night so that you can spend the time
learning? Can they pick a few things up for you at the store or do a load of laundry? Can
they let other people know you are going through a difficult time and could use a hand?
Talk to someone. Everyone needs someone to talk to. Let someone know what you
are going through and how you feel. Someone who just listens can be a great
source of strength. If you can’t get out of the house, use the phone to call a friend.
16
Consider joining a support group. It may be helpful to listen or talk to people who
have been or are going through a similar experience. Support groups can be great
sources of information about what services are available in your area and who provides
them. You may have to try more than one to find a group that feels right to you. You may
find you aren’t a “support group kind of person.” For many parents in your situation,
support groups provide valuable hope, comfort and encouragement.
#
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#
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Consider attending a recreational program for children with autism. This may be a
good way to meet other parents just like you.
17
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18
Try to take a break. If you can, allow yourself to take some time away, even if it is
only a few minutes to take a walk. If it’s possible, getting out to a movie, going
shopping, or visiting a friend can make a world of difference. If you feel guilty about
taking a break, try to remind yourself that this break will help you feel renewed for the
things you need to do when you get back. Try to get some rest. If you are getting regular
sleep, you will be better prepared to make good decisions, be more patient with your
child, and more able to deal with the stress in your life.
Consider keeping a journal. Louise DeSalvo, in Writing as a Way of Healing, notes

that studies have shown that: “Writing that describes traumatic events and our
deepest thoughts and feelings about them is linked with improved immune function,
improved emotional and physical health,” and positive behavioral changes. Some
parents have found a journal a helpful tool for keeping track of their child’s progress,
what is working and what isn’t. Be mindful of the time you spend on the Internet. The
Internet will be one of the most important tools you have for learning what you need to
know about autism and how to help your child. Unfortunately, there is more information
on the web than any of us have time to read in a lifetime. There may also be a lot of
misinformation.
Right now, while you are trying to make the most of every minute, keep an eye on the
clock and frequently ask yourself these important questions:
!'#;%0$#!],#.*0:&">#.&>%$#"5;#7*.B#/&(*/B#$5#-*#.*/*70"$#$5#,B#=%&/:H#
!'#&$#"*;#&"45.,0$&5"H#
!'#&$#%*/94+/H#
!'#&$#4.5,#0#.*/&0-/*#'5+.=*H#
#
Sometimes, the time you spend on the Internet will be incredibly valuable. Other times, it
may be better for you and your child if you use that time to take care of yourself.
F%*#!"$*."*$#;&//#-*#5"*#54#$%*#,5'$#&,95.$0"$#$55/'#B5+#%07*#45.#/*0."&">#;%0$#
B5+#"**:#$5#("5;#0-5+$#0+$&',#0":#%5;#$5#%*/9#B5+.#=%&/:C#
#
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#
19
G%0$#<%5+/:#G*#h"5;#2-5+$#A+.#
b5+">*.#5.#X+$+.*#D%&/:.*"H##
As discussed below, genetic risk factors contribute to autism. If you are
expecting another child, or have plans to expand your family in the future, you
may be concerned about the development of any younger siblings of your child
with autism. Published studies have estimated that families affected with one child with
autism have roughly a 5-10% percent chance of having a second child with autism.
However, statistics are changing and there are several ongoing research studies that
are studying the recurrence rate, or likelihood that autism will be diagnosed in a second
or third child. For the most recent findings and updated research on the rate of
recurrence and susceptibility of autism in siblings, please visit www.earlistudy.org. The
EARLI study is a nationwide effort to investigate the genetic and environmental
contributions to autism in a high risk group, that is, younger siblings of a child who has
received a diagnosis.
More recent evidence has suggests that early signs of autism may be seen in some
children as young as 8-10 months of age. For example, infants who later develop autism
may be more passive, are more difficult to soothe, or fail to orient when their name is
called. Some of these early signs may be noticed by parents, others may only be
observed with the help of a trained clinician.
Through a joint venture between Autism Speaks and the National Institute of Child
Health and Human Development, research on the early signs and symptoms of autism
has been accelerated. Called the High Risk Baby Siblings Research Consortium, or
BSRC, the collaboration is comprised of over 20 researchers at a dozen different sites in
the US, Canada, Israel and the United Kingdom. The purpose of this collaborative effort
is to help identify behavioral and biological markers for autism so that diagnosis can be
made earlier than ever before, leading to improved and more specific behavioral
intervention in young children and even infants. While there is a general acceptance in
the scientific community that “earlier is better”, this research will provide evidence on
different therapies which partner therapist time and parent training. Recently, a group of
researchers within the BSRC, together with psychologists from around the US, has
formed the Autism Speaks Toddler Treatment Network (TTN). The goal of the network is
to determine whether intervention between the ages of 18 to 24 months of age affects
developmental outcome at an age when autism can be more reliably diagnosed. A
number of other projects are underway to better identify developmental paths of children
with autism, as well as potential risk factors, and common neurobiological markers.
!4#B5+#0.*#&"$*.*'$*:#&"#90.$&=&90$&">#&"#0#.*'*0.=%#9.5L*=$#'$+:B&">#$%*#*0./&*'$#
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20
These studies provide intense observation, documentation, and feedback by experts in
the field on the development of your child with autism, and any other children at risk for
autism. If you are interested in other intervention programs that are not part these
studies, visit the Family Services Resource Guide on the Autism Speaks website to help
find an early intervention program in your area.
(www.autismspeaks.org/community/resources)
O5;#G&//#F%&'#244*=$#A+.#X0,&/BH#
Even though it is your child who has the diagnosis, it is important to acknowledge
that autism affects the whole family. This section of your handbook may help you
anticipate some of the emotions you and other people in your family will
experience. The following article, adapted from Does My Child Have Autism? by Wendy
L. Stone, Ph.D., provides some helpful information for talking to your parents and close
family members about the diagnosis.
S.*0(&">#$%*#"*;'#
Sometimes telling your parents about your child’s diagnosis can be extremely
difficult, especially with your own emotions running so high. It’s hard to know what
to expect; I’ve seen that parental reactions to this news can vary dramatically. One
young mother told me, “My mother-in-law told us that we shouldn’t bring my son to family
gatherings until he grows up. It’s heartbreaking to hear her say that she would rather not
see any of us for years instead of trying to understand her own grandson.” But then I’ve
also been told, “We were very touched by how our family reacted to my son’s diagnosis.
Everyone asked what they could do to help, and they showed us so much support. I
know his grandparents read books and articles on the disorder so they could better
understand him. My mother even quit her job to help me through this very difficult time.”
Yes, reactions vary widely. But whatever reaction you get, it will be very important to
educate your parents about the nature of autism after you have told them about the
diagnosis. To begin your discussion, you might talk about specific behaviors. For
example: “You know those behaviors we’ve been confused about for so long? Well, now
we have a name for them and an explanation for why they occur. Howie doesn’t act the
way he does because he’s spoiled or because he’s shy or because he doesn’t like us –
he acts that way because he has autism. Autism explains why he doesn’t speak or use
gestures and why he doesn’t seem to understand what we say. It explains why he’s not
as interested in interacting with us as the other children in the family have been and why
he plays with spoons and bottles instead of toys. I know this is upsetting news for all of
us. But the good news is that the disorder has been diagnosed early, and there are a lot
of things we can do to help him. He’ll be starting some therapies soon, and I’ll be
learning about things I can do to help him at home. I know that you will need some time
to think about all of this. But if you have any questions as we begin his therapy, I’ll be
glad to try my best to answer them. I know we’re all hoping for the best outcome
possible.” After the initial conversation about this diagnosis, continue to keep your other
children and your extended family in the information loop. Autism doesn’t affect only one
child. It affects the entire family.
"
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21
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The following article by Lynn Kern Koegel, Ph.D. and Claire LaZebnik, from the
book Overcoming Autism, offers a suggestion for how to tell people and explains
why, for some people, it can make life easier for you and your friends.
F*//&">#6*59/*#
You should, you know. Tell people. You don’t have to walk up to strangers on the
street or anything, but confide in the people who love you. That was one thing we
did right: we told our families and our friends right away. First we called them, and then
we copied a good comprehensive article someone wrote about autism and annotated it
with specifics about Andrew, and we mailed it out to everyone we knew. (You could do
the same things with sections from this book, by the way.) None of our good friends
pulled away from us because our kid had autism. Just the opposite – our friends and
families rallied around us in amazing ways and have continued to cheer Andrew’s
progress on year after year. In all honesty, telling people what we were going through
only made our lives easier. Before then, we worried that Andrew’s occasionally aberrant
behavior was off-putting. But once he had a formal diagnosis, everyone cut us a lot of
slack, and instead of wondering what the hell was wrong with us as parents, most
people we knew admitted to a newfound respect for us for dealing with so much. Real
friends don’t love you more for being successful or less for having problems. If anything,
it works the opposite way – we’re all so busy that sometimes we forget to stay in touch
with friends when everything’s fine for them, but we rush forward when they need us.
Now is the time to take advantage of that. Talk your friends’ ears off, complain, bitch and
moan to them. You’re dealing with a huge challenge, take advantage of every minor plus
it has to offer.
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#
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22
X&4$**"#F&9'#45.#b5+.#X0,&/B
As a result of her work with many families who deal so gracefully with the
challenges of autism, Family Therapist Kathryn Smerling, Ph.D., offers these five
tips for parents, five for siblings and five for extended family members:
#
f#F&9'#45.#60.*"$'##
! Learn to be the best advocate you can be for your child. Be informed. Take
advantage of all the services that are available to you in your community. You will
meet practitioners and providers who can educate you and help you. You will gather
great strength from the people you meet.
! Don’t#push your feelings away. Talk about them. You may feel both ambivalent and
angry. Those are emotions to be expected. It’s OK to feel conflicting emotions.
! Try#to direct your anger towards the disorder and not towards your loved ones. When
you find yourself arguing with your spouse over an autism related issue, try to
remember that this topic is painful for both of you; and be careful not to get mad at
each other when it really is the autism that has you so upset and angry. Try to have
some semblance of an adult life. Be careful to not let autism consume every waking
hour of your life. Spend quality time with your typically developing children and your
spouse, and refrain from constantly talking about autism. Everyone in your family
needs support, and to be happy despite the circumstances.
! Appreciate#the small victories your child may achieve. Love your child and take great
pride in each small accomplishment. Focus on what they can do instead of making
comparisons with a typically developing child. Love them for who they are rather than
what they should be.
! Get involved with the Autism community. Don’t underestimate the power of
“community”. You may be the captain of your team, but you can’t do everything
yourself. Make friends with other parents who have children with autism. By meeting
other parents you will have the support of families who understand your day to day
challenges. Getting involved with autism advocacy is empowering and productive.
You will be doing something for yourself as well as your child by being proactive.
# 1Y*0."&">#,5.*#0-5+$#,B#=%&/:]'#+"&N+*#"**:'#0":#0-&/&$&*'#0/5">#;&$%#
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#
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23
f#F&9'#45.#S.5$%*.'#i#<&'$*.'#
! Remember#that you are not alone! Every family is confronted with life’s challenges
and yes, autism is challenging but, if you look closely, nearly everyone has
something difficult to face in their families.
! Be proud of your brother or sister. Learn to talk about autism and be open and
comfortable describing the disorder to others. If you are comfortable with the
topic they will be comfortable too. If you are embarrassed by your brother or sister,
your friends will sense this and it will make it awkward for them. If you talk openly to
your friends about autism, they will become comfortable. But, like everyone else,
sometimes you will love your brother or sister, and sometimes you will hate them. It’s
okay to feel your feelings. And, often it’s easier when you have a professional
counselor to help you understand them – someone special who is here just for you!
Love your brother or sister the way they are.
! While it is OK to be sad that you have a brother or sister affected by autism it doesn’t
help to be upset and angry for extended periods of time. Your anger doesn’t change
the situation; it only makes you unhappier. Remember your Mom and Dad may have
those feelings too.
! Spend time with your Mom and Dad alone. Doing things together as a family with
and without your brother or sister strengthens your family bond. It’s OK for you to
want alone time. Having a family member with autism can often be very time
consuming, and attention grabbing. You need to feel important too. Remember, even
if your brother or sister didn’t have autism, you would still need alone time with Mom
and Dad.
! Find an activity you can do with your brother or sister. You will find it rewarding to
connect with your brother or sister, even if it is just putting a simple puzzle together.
No matter how impaired they may be, doing something together creates a closeness.
They will look forward to these shared activities and greet you with a special smile.
;2$#4&.'$#!#4*/$#/5'$#0":#=5"4+'*:#0-5+$#,B#-.5$%*.#-+$#"5;#$%0$#,B#M5,#0":#
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24
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! Family members have a lot to offer. Each family member is able to offer the things
they have learned to do best over time. Ask how you can be helpful to your family.
Your efforts will be appreciated whether it means taking care of the child so that the
parents can go out to dinner, or raising money for the special school that helps your
family’s child. Organize a lunch, a theatre benefit, a carnival, or a card game. It will
warm your family’s hearts to know that you are pitching in to create support and
closeness.
! Seek out your own support. If you find yourself having a difficult time accepting and
dealing with the fact that your loved one has autism, seek out your own support.
Your family may not be able to provide you with that kind of support so you must be
considerate and look elsewhere. In this way you can be stronger for them, helping
with the many challenges they face. Be open and honest about the disorder. The
more you talk about the matter, the better you will feel. Your friends and family can
become your support system but only if you share your thoughts with them. It may
be hard to talk about it at first, but as time goes on it will be easier. In the end your
experience with autism will end up teaching you and your family profound life
lessons.
! Put judgment aside. Consider your family’s feelings and be supportive. Respect the
decisions they make for their child with autism. They are working very hard to
explore and research all options, and are typically coming to well thought out
conclusions. Try not to compare children (this goes for typically developing kids as
well). Children with autism can be brought up to achieve their personal best.
! Learn more about Autism. It affects people of all social and economic standing.
There is promising research, with many possibilities for the future. Share that sense
of hope with your family, while educating yourself about the best ways to help
manage this disorder.
! Carve out special time for each child. You can enjoy special moments with both
typically developing family members and the family member with autism. Yes, they
may be different, but all of the children look forward to spending time with you.
Children with autism thrive on routines, so find one thing that you can do together
that is structured, even if it is simply going to a park for fifteen minutes. If you go to
the same park every week, chances are over time that activity will become easier
and easier it just takes time and patience. If you are having a difficult time trying to
determine what you can do, ask your family. They will sincerely appreciate the effort
that you are making.
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25
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The road ahead will be bumpy. There will be times when your progress stalls or
takes an unexpected turn. When it does, try to remind yourself that these are
speed bumps, not roadblocks. Take them one at a time. It is important that you
start now. There are a variety of services available to treat and educate your child. The
article below, from Does My Child Have Autism? by Wendy L. Stone, PhD, with Theresa
Foy DiGeromino, MEd, explains why:
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26
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Every child has the right to a free appropriate education. The Individuals with
Disabilities Education Act (IDEA), enacted in 1975, mandates a public
education for all eligible children and makes the schools responsible for providing
the supports and services that will allow this to happen. IDEA was most recently revised
in 2004 (and, in fact, renamed the Individuals with Disabilities Education Improvement
Act, but most people still refer to it as IDEA). The law mandates that the state provide an
eligible child with a free appropriate public education that meets his or her unique
individual needs. IDEA specifies that children with various disabilities, including autism,
are entitled to early intervention services and special education. In addition, the IDEA
legislation has established an important team approach and a role for parents as equal
partners in the planning for an individual child, and promotes an education in the least
restrictive environment. In addition to the IDEA stipulations, the Americans with
Disabilities Act of 1990 (ADA) sets forth, as a civil right, protections and provisions for
equal access to education for anyone with a disability. Section 504 of the Rehabilitation
Act of 1973 is another civil rights law that prohibits discrimination on the basis of
disability in programs and activities, public and private that receive federal financial
assistance. Generally, the individuals protected by these laws include anyone with a
physical or mental impairment that substantially limits one or more life activities.
Advocating for your child’s education is a very important role, and at times can seem
overwhelming and confusing. Two books that may be helpful are Wrightslaw: From
Emotions to Advocacy - The Special Education Survival Guide, by Pam Wright and Pete
Wright and How to Compromise with Your School District Without Compromising Your
Child, by Gary Mayerson. You will also find additional books and websites at the back of
this kit that will also be helpful in this process.
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As described previously, IDEA provides for a “free and appropriate education” for all
children with disabilities. Each word in this phrase is important, but “appropriate” is
the one that relates specifically to your special needs child. Your child is entitled to an
education that is tailored to his or her special needs and a placement that will allow them
to make educational progress. Although you and your child’s teachers or therapists may
want to provide your child with the best and optimal programs and services, the school
district is simply required to provide an appropriate education. One of the challenges
here is working with the school district to determine what is appropriate and, therefore,
what will be provided for your child. This is a collaborative process, and may require
considerable negotiation in order to secure the appropriate services from the school.
#
27
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IDEA also provides that children with disabilities are entitled to experience the “least
restrictive environment” in schools. This means that a school district is required to
educate a student with a disability in regular classrooms, with his non-disabled peers.
The child must be educated in the school he or she would attend if not disabled, to the
maximum extent appropriate, and supported with the aids and services required to make
this possible. This does not mean that every student has to be in a general education
classroom, but the objective is to place the student in as natural a learning environment
as possible, within his home community. This decision is made by the members of the
IEP team, with consideration of the myriad of issues related to appropriate environment
and supports for the student. Placements and the LRE for a particular student may
change over time.
The participation of children with disabilities in the general education environment is

often referred to as “mainstreaming” or “inclusion.” Inclusion does not mean that a child
with special needs should be placed into a general education setting just like a typical
learner; a variety of special education supports should be provided in order to create a
successful environment and positive experience for everyone involved. Careful planning
and training are essential to providing modifications or accommodations, and to
successfully situating a child with a disability in the least restrictive setting. These
supports might include providing a specially trained classroom or one-on-one
paraprofessional, altering testing environments or expectations, adapting curriculum,
providing visual supports or adaptive equipment, etc. The special education department
should provide training, strategies and support for general education staff and others in
the general school community who may interact with students with special needs. It is
important to note that philosophies about inclusion vary considerably among school
districts, staff and parents of students with and without special needs.
IDEA provides for a team approach to planning so that the objectives of all members of
the team can be considered, and the necessary supports can be put in place to
maximize inclusion. Not all parents will feel that a mainstream environment will enhance
the growth and development of their student with special needs, and allowances need to
be made to accommodate various perspectives. Additionally, not all students will be
ready for full inclusion all of the time. The anxiety and sensory issues related to inclusion
may mean that efforts should begin with small steps generate ongoing success and
increasing participation within the local student body and community.
28
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The IDEA provides states with federal grants to institute early intervention
programs. Any child younger than age three who has a developmental delay, or a
physical or mental condition likely to result in a developmental delay, is eligible to
receive early intervention services through these programs. EI services can vary widely
from state to state and region to region. However, the services should address your
child’s unique needs and should not be limited to what is currently available or
customary in your region. The document that spells out your child’s needs and the
services that will be provided is the Individual Family Service Program (IFSP). The
IFSP should be based on a comprehensive evaluation of your child. It should describe
your child’s current levels of functioning and the anticipated goals. It should also list the
specific services that will be provided to your child and your family. EI services are
aimed at minimizing the impact of disabilities on the development of your child. Services
for your child may include, but are not limited to, speech and language instruction,
occupational therapy, physical therapy, Applied Behavior Analysis (ABA) and
psychological evaluation. Services for families may include training to help reinforce the
affected child’s new skills and counseling to help the family adapt.
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In this same section of the Autism Speaks Resource Guide you will also find state
specific information on the process of transitioning from Early Intervention Services to
Special Education Services.
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Special education services pick up where early intervention services leave off, at
age 3. Your local school district provides these services through their special
education department. The focus of special education is different from that of
early intervention. While early intervention addresses your child’s overall development,
special education focuses on providing your child with an education, regardless of
disabilities or special needs. The document that spells out your child’s needs and how
these needs will be met is the Individualized Education Program (IEP). Like the IFSP,
the IEP describes your child’s strengths and weaknesses, sets goals and objectives, and
details how these can be met. Unlike the IFSP, the IEP is almost entirely related to how
29
the needs of your child will be met within the context of the school district and within
school walls.
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If there is evidence that your child experiences a substantial regression in skills
during school vacations, he or she may be entitled to ESY services. These
services would be provided over long breaks from school (summer vacation) to
prevent substantial regression, but not to acquire new skills. It is important for the family
to remain involved in determining appropriate goals, communicating with the educational
team about progress, and working to provide consistency between home and school.
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For Early Intervention Services, if your child is under the age of three, call your
local Early Intervention Agency. In most states Early Intervention is provided by
the Department of Health. Contact information is included in the local resource
guide of this kit. For Special Education Services, if your child is three or older, contact
your local school district, and more specifically the Office of Special Education within the
school district. In some cases, you may need to put the request in writing that you would
like your child evaluated for special education services. Refer to “Assembling Your
Team” in this kit for more information. You’ll find more information at the Autism Speaks
web site, www.AutismSpeaks.org/community/fsdb/search.php and in the Action Plan
section of this kit.
30
Before Service can be provided, it may be necessary to complete further assessments
and evaluations. These may include:
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You may find yourself spending some time in waiting rooms with your child when you are
completing additional evaluations. You have probably already figured out how helpful it
is to bring some snacks for your child, his or her favorite toy, or some other form of
entertainment to help pass the time. Having to wait for the completion of these additional
evaluations, which may be required by the school district or Early Intervention, may be
frustrating. There are sometimes waiting lists, and so it is important to start the process
as soon as possible. The additional evaluations will provide much more in-depth
information about your child’s symptoms, strengths and needs, and will be helpful for
accessing and planning therapy services in the long run.
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The purpose of the evaluations is to understand your child’s challenges so that he can
get the appropriate services that he needs. The Organization for Autism Research’s A
Parent’s Guide to Assessment can be helpful in explaining the results of the evaluations
and what they mean for your child.
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www.researchautism.org/resources/reading/documents/AssessmentGuide.pdf#
If you find you are spinning your wheels waiting for the results, there are things you can
be doing in the meantime. Talk to other parents about what services have been helpful
for their children.
Investigate the therapies outlined in this kit. Start reading about autism. (There is a list of
suggested books and web sites at the end this kit, as well as in the Autism Speaks
Resource Library at www.autismspeaks.org/community/resources/index.php#library)
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31
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Treatment for autism is usually a very intensive, comprehensive undertaking that
involves the child’s entire family and a team of professionals. Some programs
may take place in your home. These may be based in your home with
professional specialists and trained therapists or may include training for you to serve as
a therapist for your child under supervision of a professional. Some programs are
delivered in a specialized center, classroom or preschool. It is not unusual for a family to
choose to combine more than one treatment method.
"
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We’ve provided an overview of many different treatment methods for autism in this
section of your kit. The descriptions are meant to give you general information Your
pediatrician, developmental pediatrician, or a social worker who specializes in the
treatment of children with autism, can make suggestions or help you prioritize therapies
based on your child’s comprehensive evaluation. Once you have narrowed down some
choices of appropriate therapies for your child, you will want to explore more
comprehensive information before making a commitment to one. For many children,
autism is complicated by medical conditions, biological issues and symptoms that are
not exclusive to autism. Children with other disorders, such as Articulation Disorder,
Apraxia, Seizures, GI problems, etc. might require some of the same therapies.
Examples of these treatments are Speech & Language Therapy, Occupational

Therapy, or the care of a Neurologist or Gastroenterologist. For this reason, we’ve
included information here to explain the treatments for the core symptoms of autism and
the treatments for associated symptoms and biological and medical conditions. Intensive
treatments for autism’s core symptoms address the social, communication and
behavioral issues at the heart of autism. Treatments for associated symptoms address
challenges commonly associated with autism, but not specific to the disorder. If your
child has biological or medical conditions, such as allergies, food intolerances,
gastrointestinal issues or sleep disturbances, these will need to be treated too.
Treatment programs may combine therapies for both core symptoms and associated
symptoms. Your child’s treatment program will depend on his needs and strengths.
Some of these therapies may be used together. For example, if medical causes for sleep
disturbances are ruled out, a behavioral intervention might be used to address them.
Occupational Therapy or Speech & Language Therapy are often integrated into one of
the intensive therapy programs described here as core symptom therapies. Many
children benefit from receiving multiple therapies provided in the same learning format.
The National Research Council recommends that, during the preschool period, children
with autism should receive approximately 25 hours of structured intervention per week.
Intervention can include time spent in a developmental program, speech-language
therapy, occupational therapy, one-on-one or small group intervention, and parent-
delivered intervention.
32
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Many of the therapy methods described here are very complex and will require more
esearch on your part before you get started. Whenever possible, observe the therapies
in action. Talk to experienced parents and make sure you have a thorough
understanding of what is involved before beginning any therapy for your child.
#
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33
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Most families use one type of intensive intervention that best meets the needs of
their child and their parenting style. The intensive interventions described here
require multiple hours per week of therapy, and address behavioral,
developmental, and/or educational goals. They are developed specifically to treat
autism. During the course of treatment, it may be necessary to reevaluate which method
is best for your child.
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Before we get into the types of therapies available, it is helpful to take a step back and
look at the bigger picture. Although research and experience have revealed many of the
mysteries surrounding autism, it remains a complex disorder that impacts each child
differently. However, many children with autism have made remarkable breakthroughs
with the right combination of therapies and interventions. Most parents would welcome a
cure for their child, or a therapy that would alleviate all of the symptoms and challenges
that make life difficult for them. Just as your child’s challenges can’t be summed up in
one word, they can’t be remedied with one therapy. Each challenge must be addressed
with an appropriate therapy. No single therapy works for every child. What works for one
child may not work for another. What works for one child for a period of time may stop
working. Some therapies are supported by research showing their efficacy, while others
are not. The skill, experience, and style of the therapist are critical to the effectiveness of
the intervention.
Before you choose an intervention, you will need to investigate the claims of each
therapy so that you understand the possible risks and benefits for your child. At first, all
of these techniques, ABA, VB, PRT, DTT, ESDM, among others, may seem like
alphabet soup to you. You may be confused now, but you will be surprised at how
quickly you become “fluent” in the terminology of autism therapies.
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7&'&$#;;;C2+$&',<9*0('C5.>#0":#7&*;#$%*#@0$&5"0/#<$0":0.:'#6.5L*=$#
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b5+#'%5+/:#0/'5#'**#B5+.#9*:&0$.&=&0"#45.#,5.*#&"45.,0$&5")#'5#$%0$#B5+#=0"#-*#
=5"4&:*"$#B5+#0.*#,0(&">#&"45.,*:#=%5&=*'#0'#B5+#-*>&"#$5#"0..5;#:5;"#B5+.#
59$&5"'.
Behavior analysis was originally described by B.F. Skinner in the 1930’s. You may have
learned about Skinner and “operant conditioning” when you studied science in school.
The principles and methods of behavior analysis have been applied effectively in many
circumstances to develop a wide range of skills in learners with and without disabilities.
34
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Since the early 1960’s, applied behavior analysis, or ABA, has been used by
hundreds of therapists to teach communication, play, social, academic, self-care,
work and community living skills, and to reduce problem behaviors in learners
with autism. There is a great deal of research literature that has demonstrated that ABA
is effective for improving children’s outcomes, especially their cognitive and language
abilities. Over the past several decades, different models using ABA have emerged, all
of which use behavioral teaching. They all use strategies that are based on Skinner’s
work. ABA is often difficult to understand until you see it in action. It may be helpful to
start by describing what all of the different methods of ABA have in common. ABA
methods use the following three step process to teach:
! An antecedent, which is a verbal or physical stimulus such as a command or

request. This may come from the environment or from another person, or be internal
to the subject;
! A resulting behavior, which is the subject’s (or in this case, the child’s) response or
lack of response to the antecedent;
! A consequence, which depends on the behavior. The consequence can include
positive reinforcement of the desired behavior or no reaction for incorrect responses.
ABA targets the learning of skills and the reduction of challenging behaviors. Most
ABA programs are highly-structured. Targeted skills and behaviors are based on an
established curriculum. Each skill is broken down into small steps, and taught using
prompts, which are gradually eliminated as the steps are mastered. The child is
given repeated opportunities to learn and practice each step in a variety of settings.
Each time the child achieves the desired result, he receives positive reinforcement,
such as verbal praise, or something else that the child finds to be highly motivating,
like a small piece of candy. ABA programs often include support for the child in a
school setting with a one-on-one aide to target the systemic transfer of skills to a
typical school environment. Skills are broken down into manageable pieces and built
upon so that a child learns how to learn in a natural environment. Facilitated play
with peers is often part of the intervention. Success is measured by direct
observation and data collection and analysis – all critical components of ABA. If the
child isn’t making satisfactory progress, adjustments are made.
One type of ABA intervention is Discrete Trial Teaching (also referred to as DTT,
“traditional ABA” or the Lovaas Model, for its pioneer, Dr. Ivar Lovaas). DTT involves
teaching individual skills one at a time using several repeated teaching trials and
reinforcers that may or may not be intrinsically related to the skill that is being taught.
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A board certified behavior analyst specializing in autism will write, implement and
monitor the child’s individualized program. Individual therapists, often called
“trainers,” (not necessarily board certified) will work directly with the child on a day-to-
day basis.
35
#
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Sessions are typically 2 to 3 hours long, consisting of short periods of structured
time devoted to a task, usually lasting 3 to 5 minutes. 10 to 15 minute breaks are
often taken at the end of every hour. Free play and breaks are used for incidental
teaching or practicing skills in new environments. Done correctly, ABA intervention for
autism is not a "one size fits all" approach consisting of a "canned" set of programs or
drills. On the contrary, every aspect of intervention is customized to each learner's skills,
needs, interests, preferences, and family situation. For those reasons, an ABA program
for one learner might look somewhat different than a program for another learner. An
ABA program will also change as the needs and functioning of the learner change.
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25 to 40 hours per week. Families are also encouraged to use ABA principals in
their daily lives.
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&"$*.7*"$&5"'#$%0$#&"75/7*#2S2)#'+=%#0'#^*.-0/#S*%07&5.)#
6&75$0/#Z*'95"'*#F.*0$,*"$)#0":#$%*#[0./B#<$0.$#8*"7*.#
M5:*/H##
Verbal Behavior and Pivotal Response Treatment therapies use the methods of
ABA, but with different emphasis and techniques. All of these methods use the
three step process described above.
#
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Pivotal Response Treatment, or PRT, was developed by Dr. Robert L. Koegel,
Dr. Lynn Kern Koegel and Dr. Laura Shreibman, at the University of California,
Santa Barbara. Pivotal Response Treatment was previously called the Natural
Language Paradigm (NLP), which has been in development since the 1970s. It is a
behavioral intervention model based on the principles of ABA.
PRT is used to teach language, decrease disruptive/self-stimulatory behaviors, and

increase social, communication, and academic skills by focusing on critical, or “pivotal,”
behaviors that affect a wide range of behaviors. The primary pivotal behaviors are
motivation and initiation of communications with others. The goal of PRT is to produce
36
positive changes in the pivotal behaviors, leading to improvement in communication
skills, play skills, social behaviors and the child’s ability to monitor his or her own
behavior. Unlike the Discrete Trial Teaching (DTT) method of teaching, which targets
individual behaviors based on an established curriculum, PRT is child-directed.
Motivational strategies are used throughout intervention as often as possible. These
include varying tasks, revisiting mastered tasks to ensure the child retains acquired
skills, rewarding attempts, and using direct and natural reinforcement. The child plays a
crucial role in determining the activities and objects that will be used in the PRT
exchange. For example, a child’s purposeful attempts at functional communication are
rewarded with reinforcement related to their effort to communicate (e.g. if a child
attempts a request for a stuffed animal, the child receives the animal).
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Some psychologists, special education teachers, speech therapists and other
providers specifically are trained in PRT. The Koegel Autism Center offers a PRT
Certification program.
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Each program is tailored to meet the goals and needs of the child, and also to fit
into the family routines. A session typically involves six segments during which
language, play, and social skills are targeted in structured and unstructured formats.
Sessions change to accommodate more advanced goals and the changing needs as the
child develops.
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PRT programs usually involve 25 or more hours per week. Everyone involved in the
child’s life is encouraged to use PRT methods consistently in every part of the
child’s life. PRT has been described as a lifestyle adopted by the affected family.
#
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Another behavioral (based on the principles of ABA) therapy method with a
different approach to the acquisition and function of language is Verbal Behavior
(VB) therapy. In his 1957 book, “Verbal Behavior,” B.F. Skinner (see previous
section on ABA) detailed a functional analysis of language. He described all of the parts
of language as a system. Verbal Behavior uses Skinner’s analysis as a basis for
teaching language and shaping behavior.
37
Skinner theorized that all language could be grouped into a set of units, which he called
operants. Each operant he identified serves a different function. He listed echoics,
mands, tacts and intraverbals as the most important of these operants. The function of a
“mand” is to request or obtain what is wanted. For example, the child learns to say the
word “cookie” when he is interested in obtaining a cookie. When the child is given the
cookie, the word is reinforced and will be used again in the same context. In a VB
program, the child is taught to ask for the cookie any way he can (vocally, sign language,
etc.). If the child can echo the work, he will be motivated to do so in order to obtain the
desired object. The operant for labeling an object is called a “tact.” For example, the
child says the word “cookie” when seeing a picture and is thus labeling the item. In VB,
more importance is placed on the mand than on the tact, theorizing that “using
language” is different from “knowing language.” An “intraverbal” describes
conversational or social, language. Intraverbals allow children to discuss something that
isn’t present. For example, the child finishes the sentence, “I’m baking ” with the
intraverbal fill-in “Cookies.” Intraverbals also include responses to questions from
another person, usually answers to “wh-“questions (Who? What? When? Where?
Why?). Intraverbals are strengthened with social reinforcement.
VB and classic ABA use similar behavioral formats to work with children. VB is designed
to motivate a child to learn language by developing a connection between a word and its
value. VB may be used as an extension of the communication section of an ABA
program.
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VB therapy is provided by VB-trained psychologists, special education teachers,
speech therapists and other providers.
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VB programs usually involve 30 or more hours per week of scheduled therapy.
Families are encouraged to use VB principals in their daily lives.
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The Early Start Denver Model (ESDM) is a developmental, relationship-based
intervention approach that utilizes teaching techniques consistent with applied
behavior analysis (ABA). The goals are to foster social gains – communicative,
cognitive, and language – in young children with autism, and to reduce atypical
behaviors associated with autism. ESDM is appropriate for children with autism or
autism symptoms who are as young as 12 months of age, through preschool age. The
38
content of intervention for each child comes from assessment using a comprehensive
ESDM Curriculum Checklist which covers all domains of early development: Cognitive
Skills, Language, Social Behavior, Imitation, Fine and Gross Motor Skills, Self-help Skills
and Adaptive Behavior. Adults delivering ESDM focus on behaviors involved in
capturing and holding children’s attention, fostering their motivation for social interaction
through highly enjoyable routines, using joint play activities as the medium for treatment,
developing nonverbal and verbal communication, imitation, and joint attention, and using
reciprocal, turn-taking exchanges inside joint activity routines to foster social learning.
Based on a NIH-funded clinical trial, ESDM has been shown to be effective for
increasing IQ, language, social skills, and adaptive behavior when delivered for at least
one year.
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ESDM can be provided by ESDM-trained behavior analysts, special education
teachers, speech therapists and other providers. Parents can also be taught to use
ESDM strategies.
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ESDM programs usually involve 20-25 or more hours per week of scheduled
therapy. Families are encouraged to use ESDM strategies in their daily lives.
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ESDM is designed to be highly engaging and enjoyable for the child, while skills are
systematically taught within a naturalistic, play-based interaction. Some skills are
taught on the floor during interactive play while others are taught at the table, focusing
on more structured activities. As the child develops social skills, peers or siblings are
included in the therapy session to promote peer relationships. ESDM can be delivered
in the home, the clinic, or a birth-to-three or developmental preschool setting.
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Floortime is a specific therapeutic technique based on the Developmental
Individual Difference Relationship Model (DIR) developed in the 1980s by Dr.
Stanley Greenspan. The premise of Floortime is that an adult can help a child
expand his circles of communication by meeting him at his developmental level and
39
building on his strengths. Therapy is often incorporated into play activities – on the floor.
The goal of Floortime is to help the child reach six developmental milestones that
contribute to emotional and intellectual growth:
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In Floortime, the therapist or parent engages the child at a level the child currently
enjoys, enters the child’s activities, and follows the child’s lead. From a mutually shared
engagement, the parent is instructed how to move the child toward more increasingly
complex interactions, a process known as “opening and closing circles of
communication.”
Floortime does not separate and focus on speech, motor, or cognitive skills but rather
addresses these areas through a synthesized emphasis on emotional development. The
intervention is called Floortime because the parent gets down on the floor with the child
to engage him at his level. Floortime is considered an alternative to and is sometimes
delivered in combination with ABA therapies.
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Parents and caregivers are trained to implement the approach. Floortime-trained
psychologists, special education teachers, speech therapists, occupational
therapists may also use Floortime techniques.
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In Floortime, the parent or provider joins in the child’s activities and follows the
child’s lead. The parent or provider then engages the child in increasingly complex
interactions. During the preschool program, Floortime includes integration with typically
developing peers.
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Floortime is usually delivered in a low stimulus environment, ranging from two to
five hours a day. Families are encouraged to use the principals of Floortime in their
day to day lifestyle.
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40
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Like other therapies described in this handbook, RDI is a system of behavior
modification through positive reinforcement. RDI was developed by Dr. Steven
Gutstein as a parent-based treatment using dynamic intelligence. The goal of
RDI is to improve the long-term quality of life of individuals with autism by helping them
improve their social skills, adaptability and self-awareness. The six objectives of RDI are:
! Emotional Referencing: The ability to use an emotional feedback system to learn

from the subjective experiences of others.
! Social Coordination: The ability to observe and continually regulate one’s behavior
in order to participate in spontaneous relationships involving collaboration and
exchange of emotions.
! Declarative Language: The ability to use language and non-verbal communication
to express curiosity, invite others to interact, share perceptions and feelings and
coordinate your actions with others.
! Flexible Thinking: The ability to rapidly adapt, change strategies and alter plans
based upon changing circumstances.
! Relational Information Processing: The ability to obtain meaning based upon the
larger context; Solving problems that have no “right-and wrong” solutions.
! Foresight and Hindsight: The ability to reflect on past experiences and anticipate
potential future scenarios in a productive manner.
The program involves a systematic approach to working on building motivation and

teaching skills, focusing on the child’s current developmental level of functioning.
Children begin work in a one-on-one setting with a parent. When they are ready, they
are matched with a peer at a similar level of relationship development to form a “dyad.”
Gradually, additional children are added to the group, as well as the number of settings
in which children practice, in order to help the child form and maintain relationships in
different contexts.
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Parents, teachers and other professionals can be trained to provide RDI. Parents
may choose to work together with an RDI-certified consultant. RDI is somewhat
unique because it is designed to be implemented by parents. Parents learn the program
through training seminars, books and other materials and can collaborate with an RDI-
certified consultant. Some specialized schools offer RDI in a private school setting.
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In RDI, the parent or provider uses a comprehensive set of step-by-step,
developmentally appropriate objectives in everyday life situations, based on
41
different levels, or stages, of ability. Spoken language may be limited in order to
encourage eye contact and non-verbal communication. RDI may also be delivered in a
specialized school setting.
#
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Families most often use the principles of RDI in their day to day lifestyle. Each
family will make choices based on their child.
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TEACCH is a special education program, developed by Eric Schopler, PhD and
his colleagues at the University of North Carolina in the early 1970s. TEACCH’s
intervention approach is called “Structured Teaching.” Structured Teaching is
based on what TEACCH calls the “Culture of Autism.” The Culture of Autism refers to
the relative strengths and difficulties shared by people with autism that are relevant to
how they learn. Structured Teaching is designed to capitalize on the relative strengths
and preferences for processing information visually, while taking into account the
recognized difficulties. Children with autism are assessed in order to identify emerging
skills, and work then focuses on these skills to enhance them. In Structured Teaching,
an individualized plan is developed for each student. The plan creates a highly
structured environment to help the individual map out activities. The physical and social
environment is organized using visual supports so that the child can more easily predict
and understand daily activities and as a result, respond in appropriate ways. Visual
supports are also used to make individual tasks understandable.
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TEACCH programs are usually conducted in a classroom setting. TEACCH-based
home programs are also available and are sometimes used in conjunction with a
TEACCH-based classroom program. Parents work with professionals as co-therapists
for their children so that TEACCH techniques can be continued in the home.
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TEACCH is available at the TEACCH centers in North Carolina, and through
TEACCH-trained psychologists, special education teachers, speech therapists and
other providers in other areas of the country.
42
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SCERTS is an educational model developed by Barry Prizant, PhD, Amy
Wetherby, PhD, Emily Rubin and Amy Laurant. SCERTS uses practices from
other approaches including ABA (in the form of PRT), TEACCH, Floortime and
RDI. The SCERTS Model differs most notably from the focus of “traditional” ABA by
promoting child-initiated communication in everyday activities. SCERTS is most
concerned with helping children with autism to achieve “Authentic Progress,” which is
defined as the ability to learn and spontaneously apply functional and relevant skills in a
variety of settings and with a variety of partners. The acronym “SCERTS” refers to the
focus on:
! “SC” Social Communication - Development of spontaneous, functional
communication, emotional expression and secure and trusting relationships with
children and adults.
! “ER” Emotional Regulation - Development of the ability to maintain a well-regulated
emotional state to cope with everyday stress, and to be most available for learning
and interacting.
! “TS” Transactional Support - Development and implementation of supports to help
partners respond to the child’s needs and interests, modify and adapt the
environment, and provide tools to enhance learning (e.g., picture communication,
written schedules, and sensory supports). Specific plans are also developed to
provide educational and emotional support to families, and to foster teamwork
among professionals.
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The SCERTS Model favors having children learn with and from other children who
provide good social and language models in inclusive settings, as much as
possible. SCERTS is implemented using transactional supports put in place by a team,
such as environmental accommodations, and learning supports, like schedules or visual
organizers.
G%5#9.57&:*'#<D[ZF<H##
SCERTS is usually provided in a school setting by SCERTS-trained special
education teachers or speech therapists.
G%*.*#=0"#!#4&":#,5.*#&"45.,0$&5"#5"#<D[ZF<H#
<D[ZF<#
;;;C<D[ZF<C=5,##
43
S0..B#6.&W0"$#
;;;CS0..B6.&W0"$C=5,#
F.*0$,*"$#45.#S&5/5>&=0/#i#M*:&=0/#
D5":&$&5"'#2''5=&0$*:#;&$%#2+$&',##
The next section of this handbook covers a number of what are frequently called
“related services.” These services are therapies that address symptoms
commonly associated with autism, but not specific to the disorder.
<9**=%?Y0">+0>*#F%*.09B#Q<YFR##
Speech-Language Therapy (SLT) encompasses a variety of techniques and
addresses a range of challenges for children with autism. For instance, some
individuals with autism are unable to speak. Others seem to love to talk. They may have
difficulty understanding information, or they may struggle to express themselves. SLT is
designed to coordinate the mechanics of speech and the meaning and social value of
language. An SLT program begins with an individual evaluation by a speech-language
pathologist. The therapy may then be conducted one-on-one, in a small group, or in a
classroom setting. The therapy may have different goals for different children.
Depending on the verbal aptitude of the individual, the goal might be to master spoken
language or it might be to learn signs or gestures to communicate. In each case, the aim
is to help the individual learn useful and functional communication. SLT is provided by
Speech-Language Pathologists who specialize in children with autism. Most intensive
therapy programs address speech-language therapy as well.
A==+90$&5"0/#F%*.09B#QAFR#
Occupational Therapy (OT) brings together cognitive, physical and motor skills. The
aim of OT is to enable the individual to gain independence and participate more
fully in life. For a child with autism, the focus may be on appropriate play, learning, and
basic life skills. An occupational therapist will evaluate the child’s development as well as
the psychological, social and environmental factors that may be involved. The therapist
will then prepare strategies and tactics for learning key tasks to practice at home, in
school, and other settings. Occupational therapy is usually delivered in 30 minute to one
hour sessions with the frequency determined by the needs of the child. Goals of an OT
program might include independent dressing, feeding, grooming, and use of the toilet, as
well as improved social, fine motor and visual perceptual skills. OT is provided by
Certified Occupational Therapists.
<*"'5.B#!"$*>.0$&5"#Q<!X''
Sensory Integration (SI) therapy is designed to identify disruptions in the way the
individual’s brain processes movement, touch, smell, sight and sound, and help he
or she process these senses in a more productive way. It is sometimes used alone, but
is often part of an occupational therapy program. It is believed that SI does not teach
higher-level skills, but rather enhances sensory processing abilities, allowing the child to
be more available to acquire higher-level skills. Sensory Integration therapy might be
44
used to help calm your child, to help reinforce a desired behavior, or to help with
transitions between activities. Therapists begin with an individual evaluation to determine
your child’s sensitivities. The therapist then plans an individualized program for the child,
matching sensory stimulation with physical movement, to improve the way the brain
processes and organizes sensory information. SI therapy often includes equipment such
as swings, trampolines and slides. Certified Occupational and Physical Therapists
provide Sensory Integration Therapy.
'
6%B'&=0/#F%*.09B#Q6FR##
Physical Therapy (PT) is focused on any problems with movement that cause
functional limitations. Children with autism frequently have challenges with motor
skills such as sitting, walking, running or jumping. PT can address poor muscle tone,
balance and coordination. A physical therapist will start by evaluating the developmental
level and abilities of the child. Once they identify the individual’s challenges, the physical
therapists design activities that target those areas. PT might include assisted movement,
various forms of exercise, and orthopedic equipment. Physical therapy is usually
delivered in 30 minute to one hour sessions by a Certified Physical Therapist, with the
frequency determined by the needs of the child.
<5=&0/#<(&//'#
Individuals with autism have a great deal of difficulty with social interactions. In
recent years, social skills training, in both one-on-one and peer group settings, has
become a very common treatment for facing this particular challenge. Social skills taught
during training sessions range from simple skills like eye contact, to more difficult skills
like inviting a peer for a play date. Studies have shown that this type of intervention
program can significantly improve social competence and social skill development.
Though social skills training is not an official or certified form of therapy, professionals
like social workers, speech therapists, and psychologists often focus largely on
improving social skills when treating both children and adults with autism. In addition,
parents, family members, and other caregivers can be taught effective ways to help
improve the social skills of their loved ones with autism inside and outside the home on a
regular basis.
#
6&=$+.*#[P=%0">*#D5,,+"&=0$&5"#<B'$*,#
Picture Exchange Communication System (PECS) is a learning system that allows
children with little or no verbal ability to communicate using pictures. PECS can be
used at home, in the classroom or in a variety of other settings. A therapist, teacher or
parent helps the child to build a vocabulary, and to articulate desires, observations or
feelings by using pictures consistently. The PECS program starts by teaching the child
how to exchange a picture for an object. Eventually, the individual is shown how to
distinguish between pictures and symbols and use them to form sentences. Although
PECS is based on visual tools, verbal reinforcement is a major component, and verbal
communication is encouraged. Standard PECS pictures can be purchased as a part of a
manual, or pictures can be gathered from photos, newspapers, magazines, or other
books.
'
2+:&$5.B#!"$*>.0$&5"#F%*.09B#
Auditory Integration Therapy (AIT), sometimes called Sound Therapy, is sometimes
45
used to treat children with difficulties in auditory processing or sound sensitivity.
Treatment with AIT involves the patient listening to electronically modified music through
headphones during multiple sessions. There are different methods of AIT, including the
Tomatis and Berard methods. While some individuals have reported improvements in
auditory processing as a result of AIT, there are no credible studies that demonstrate its
effectiveness or support its use.
d/+$*"#X.**)#D0'*&"#X.**#8&*$#QdXDXR##
Many families of children with autism are interested in dietary and nutritional
interventions that might help some of their children’s symptoms. Anecdotal
evidence suggests that removal of gluten (a protein found in barley, rye, and wheat, and
in oats through cross contamination) and casein (a protein found in dairy products) from
an individual’s can be helpful for reducing some symptoms of autism. The theory behind
this diet is that proteins are absorbed differently in some children. Children who benefit
from the GFCF diet experience physical and behavioral symptoms when consuming
gluten or casein, rather than an allergic reaction. While there have not yet been sufficient
scientific studies to support the effectiveness of the GFCF diet for reducing symptoms of
autism, many families report that dietary elimination of gluten and casein has helped
regulate bowel habits, sleep activity, habitual behaviors, and contributed to the overall
progress of their children. Because no specific laboratory tests can predict which
children will benefit from dietary intervention, many families choose to try the diet with
careful observation by the family and the intervention team.
Families choosing a trial of dietary restriction should make sure their child is receiving
adequate nutrition by consulting their pediatrician or a nutrition specialist. Dairy products
are the most common source of calcium and Vitamin D for young children in the United
States. Many young children depend on dairy products for a balanced, regular protein
intake. Alternative sources of these nutrients require the substitution of other food and
beverage products, with attention given to the nutritional content. Substitution of gluten
free products requires attention to the overall fiber and vitamin content of a child’s diet.
Vitamin supplements may have both benefits and side effects. Consultation with a
dietician or physician is recommended for the healthy application of a GFCF diet. This
may be especially true for children who are picky eaters.
G%0$#0-5+$#A$%*.#M*:&=0/#!"$*.7*"$&5"'H##
Right now you are eager to do everything possible to help your child. Many
parents in your position are eager to try new treatments, even those treatments
that have not yet been scientifically proven to be effective. Your hopes for a cure
for your child may make you more vulnerable to the lure of untested treatments. It is
important to remember that just as each child with autism is different, so is each child’s
response to treatments. It may be helpful to collect information about a therapy that you
are interested in trying, and speak with your pediatrician, as well as your intervention
team members, in order to discuss the potential risks/benefits and establish measurable
outcomes as well as baseline data. If you talk to the parents of older children with
autism, they can provide you with a history of therapies and biomedical interventions that
have been promised to be cures for autism over the years. Some of them may have
been helpful to a small number of children. Upon further study, none of them, so far, has
46
turned out to be a cure for the vast majority. We do know that many children get better
with intensive behavioral therapy. There is a large body of scientific evidence to support
this theory. It makes sense to focus on getting your child engaged in an intensive
behavioral program before looking at other interventions.
!'#F%*.*#2#D+.*H#
Is recovery possible? You may have heard about children who have recovered
from autism. Although relatively rare, it is estimated that approximately 10% of
children lose their diagnosis of autism. The factors that predict which children
lose their diagnosis are unknown. Children initially diagnosed with autism who lose their
diagnosis often have residual difficulties in the areas of hyperactivity, anxiety, and
depressive symptoms. Recovery from autism is usually reported in connection with
intensive early intervention, but it is unknown how much or which type of intervention
works best, or whether the recovery can be fully credited to the intervention. You may
also hear about children who reach “best outcome” status, which means they score
normally on tests for IQ, language, adaptive functioning, school placement, and
personality, but have mild symptoms on some personality and diagnostic tests. Recent
epidemiology studies estimate that approximately 60% of children with autism have IQ’s
above 70 by age 8 (70 is the cut-off point for developmental delay). Presently, there is
no reliable way of predicting which children will have the best outcomes. In the absence
of a cure or even an accurate prognosis of your child’s future, do not be afraid to believe
in your child’s potential. All children with autism will benefit from intervention. All will
make very significant, meaningful progress.
#
O5;#85#!#D%55'*#$%*#Z&>%$#!"$*.7*"$&5"H##
The two articles that follow may provide helpful information for you as you choose
between methods of therapies for your child.
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47
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48
#
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M*:&=0/#F*0,#
Your child should be supported by a pediatrician who understands developmental
issues, and who will serve as your child’s primary care provider. Depending on your
child’s needs, other medical team members may include a neurologist, geneticist,
developmental pediatrician, gastroenterologist, psychiatrist, or nutritionist.
!"$*"'&7*#!"$*.7*"$&5"#F*0,#
ABA, ESDM, Floortime, PRT, RDI, SCERTS, TEACCH and VB are all intensive
interventions. Depending on the intensity of the primary intervention, there may be
an intervention leader and several providers or therapists involved in providing the
treatment as structured by the leader.
Z*/0$*:?<*.7&=*'#F*0,#
Speech and Language Therapy, Occupational Therapy, Physical Therapy, or Social
Skills instruction are all related services. All therapists working with your child
should be communicating frequently, and using a consistent method of teaching.
#
O&.&">#F%*.09&'$'#
For parents hiring new therapists, you may want to consider the candidate as you
would any other job applicant and handle the situation accordingly. Ask for
Resumes.
Specific Things to Look for on the Resume:#

Past experience with children with autism approximately the same age as yours.
! The amount of experience the therapist has had.
! The kind of experience the therapist has had, for example, whether they have
worked in a school setting or in a private program.
! Educational background.
! Membership in professional autism organizations. If so, then they are most likely
going to conferences, thus enhancing their skills in their professionC#
D5":+=$&">#!"$*.7&*;'#
Conduct a “hands on” interview, during which the potential therapist works with the
child, following instructions to implement a skill acquisition program. It is important
to see how the potential therapist takes direction and to see how flexible they are about
changing approaches in their teaching. One would want a therapist to potentially be
open to new ideas in their teaching approaches. It’s a good idea to have them bring
video of a therapy session they have conducted with another child. This offers yet
another view of their teaching skills. If possible, observe the therapist working with
another child.
49
Check references. Be sure to talk to previous supervisors and to other parents the
therapists have worked for. Previous supervisors and other parents are often good
sources for finding additional therapists.
Consider a probation period. The therapist should be hired for a probation period,
during which sessions are videotaped or observed directly until the parent and/or the
home coordinator feels comfortable with the therapist and confident in their abilities.
Check clearances. Anyone working with your child will need to provide background
clearances from the state you live in to establish that they do not have a criminal record.
If you have chosen a home-based intervention program for your child, you will probably
be required to submit copies of those clearances to the state, county or local agency
providing services.
M0"0>&">#B5+.#F*0,#
Participate in training. Be part of the team. Your participation in team training is vital
so that you can increase your skills to successfully parent your child and
understand the goals and techniques of his or her program. Knowing the techniques and
objectives of your child’s intervention program will allow you to closely monitor his or her
progress and guide and evaluate the members of your team. Intensive intervention
programs often start with a one or two day training course where individual therapists
are trained by the primary intervention leader.
['$0-/&'%#F*0,#D5,,+"&=0$&5"##
There are two important ways your team will communicate. One is through a
notebook in which each therapist records information after their session with your
child. Each therapist reads the information recorded since their last session before their
next session with your child. Parents and supervisors can add information to the
notebook as needed. The other way is through Team Meetings. Team meetings are
often held at the home of the child, especially in the case of intervention programs that
are home-based. These meetings should include as many members of your team as
possible. This will ensure that your therapists are up to date on every aspect of the
program, and that they are all working with your child in consistent ways. At team
meetings, you will discuss what is working, as well as areas in which there have not
been progress, so that you can determine whether to make changes and what those
changes should be. Teams usually meet once a month, but may meet more or less often
as needed. Many team meetings include time for therapists to observe each other in
action with your child and receive feedback on their techniques.
#
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50
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.*N+&.*:#$5#&,9/*,*"$#:.&//#$B9*#&"$*.7*"$&5"'#%07*#>.*0$*.#'$.*''#$%0"#;%*"#
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#
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51
O5;#;*//#$%*#40,&/B#4+"=$&5"'#0'#0#;%5/*#&'#L+'$#0'#&,95.$0"$#0'#%5;#;*//#$%*#
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F*"#F%&">'#[7*.B#D%&/:#;&$%#2+$&',#G&'%*'#b5+#h"*;#
By Ellen Notbohm
Some days it seems the only predictable thing about it is the unpredictability. The
only consistent attribute – the inconsistency. There is little argument on any level
but that autism is baffling, even to those who spend their lives around it. The child
who lives with autism may look “normal” but his behavior can be perplexing and
downright difficult. Autism was once thought an “incurable” disorder, but that notion is
crumbling in the face knowledge and understanding that is increasing even as you read
this. Every day, individuals with autism are showing us that they can overcome,
compensate for and otherwise manage many of autism’s most challenging
characteristics. Equipping those around our children with simple understanding of
autism’s most basic elements has a tremendous impact on their ability to journey
towards productive, independent adulthood. Autism is an extremely complex disorder
but for purposes of this one article, we can distill its myriad characteristics into four
fundamental areas: sensory processing challenges, speech/language delays and
impairments, the elusive social interaction skills and whole child/self-esteem issues. And
though these four elements may be common to many children, keep front of-mind the
fact that autism is a spectrum disorder: no two (or ten or twenty) children with autism will
be completely alike. Every child will be at a different point on the spectrum. And, just as
importantly – every parent, teacher and caregiver will be at a different point on the
spectrum. Child or adult, each will have a unique set of needs.
O*.*#0.*#$*"#$%&">'#*7*.B#=%&/:#;&$%#0+$&',#;&'%*'#B5+#("*;T#
#
I am first and foremost a child. I have autism. I am not primarily “autistic.” My autism
is only one aspect of my total character. It does not define me as a person. Are you
a person with thoughts, feelings and many talents, or are you just fat (overweight),
myopic (wear glasses) or klutzy (uncoordinated, not good at sports)? Those may be
things that I see first when I meet you, but they are not necessarily what you are all
about. As an adult, you have some control over how you define yourself. If you want to
single out a single characteristic, you can make that known. As a child, I am still
unfolding. Neither you nor I yet know what I may be capable of. Defining me by one
characteristic runs the danger of setting up an expectation that may be too low. And if I
get a sense that you don’t think I “can do it,” my natural response will be: Why try?
My sensory perceptions are disordered. Sensory integration may be the most

difficult aspect of autism to understand, but it is arguably the most critical. It means
that the ordinary sights, sounds, smells, tastes and touches of everyday that you may
not even notice can be downright painful for me. The very environment in which I have to
live often seems hostile. I may appear withdrawn or belligerent to you but I am really just
trying to defend myself. Here is why a “simple” trip to the grocery store may be hell for
me: My hearing may be hyper-acute. Dozens of people are talking at once. The
loudspeaker booms today’s special. Music whines from the sound system. Cash
registers beep and cough, a coffee grinder is chugging. The meat cutter screeches,
babies wail, carts creak, the fluorescent lighting hums. My brain can’t filter all the input
and I’m in overload! My sense of smell may be highly sensitive. The fish at the meat
52
counter isn’t quite fresh, the guy standing next to us hasn’t showered today, the deli is
handing out sausage samples, the baby in line ahead of us has a poopy diaper, they’re
mopping up pickles on aisle 3 with ammonia .I can’t sort it all out. I am dangerously
nauseated. Because I am visually oriented (see more on this below), this may be my first
sense to become over-stimulated. The fluorescent light is not only too bright, it buzzes
and hums. The room seems to pulsate and it hurts my eyes. The pulsating light bounces
off everything and distorts what I am seeing -- the space seems to be constantly
changing. There’s glare from windows, too many items for me to be able to focus (I may
compensate with “tunnel vision”), moving fans on the ceiling, so many bodies in constant
motion. All this affects my vestibular and proprioceptive senses, and now I can’t even tell
where my body is in space.
Please remember to distinguish between won’t (I choose not to) and can’t (I am not
able to). Receptive and expressive language and vocabulary can be major
challenges for me. It isn’t that I don’t listen to instructions. It’s that I can’t understand you.
When you call to me from across the room, this is what I hear: “*&^%$#@, Billy.
#$%^*&^%$&* ” Instead, come speak directly to me in plain words: “Please put
your book in your desk, Billy. It’s time to go to lunch.” This tells me what you want me to
do and what is going to happen next. Now it is much easier for me to comply.
I am a concrete thinker. This means I interpret language very literally. It’s very
confusing for me when you say, “Hold your horses, cowboy!” when what you really
mean is “Please stop running.” Don’t tell me something is a “piece of cake” when there is
no dessert in sight and what you really mean is “this will be easy for you to do.” When
you say “Jamie really burned up the track,” I see a kid playing with matches. Please just
tell me “Jamie ran very fast.” Idioms, puns, nuances, double entendres, inference,
metaphors, allusions and sarcasm are lost on me.
Please be patient with my limited vocabulary. It’s hard for me to tell you what I need
when I don’t know the words to describe my feelings. I may be hungry, frustrated,
frightened or confused but right now those words are beyond my ability to express. Be
alert for body language, withdrawal, agitation or other signs that something is wrong. Or,
there’s a flip side to this: I may sound like a “little professor” or movie star, rattling off
words or whole scripts well beyond my developmental age. These are messages I have
memorized from the world around me to compensate for my language deficits because I
know I am expected to respond when spoken to. They may come from books, TV, the
speech of other people. It is called “echolalia.” I don’t necessarily understand the context
or the terminology I’m using. I just know that it gets me off the hook for coming up with a
reply.
Because language is so difficult for me, I am very visually oriented. Please show me
how to do something rather than just tell me. And please be prepared to show me
many times. Lots of consistent repetition helps me learn. A visual schedule is extremely
helpful as I move through my day. Like your day-timer, it relieves me of the stress of
having to remember what comes next, makes for smooth transition between activities,
and helps me manage my time and meet your expectations. I won’t lose the need for a
visual schedule as I get older, but my “level of representation” may change. Before I can
read, I need a visual schedule with photographs or simple drawings. As I get older, a
combination of words and pictures may work, and later still, just words.
Please focus and build on what I can do rather than what I can’t do. Like any other
human, I can’t learn in an environment where I’m constantly made to feel that I’m
53
not good enough and that I need “fixing.” Trying anything new when I am almost sure to
be met with criticism, however “constructive,” becomes something to be avoided. Look
for my strengths and you will find them. There is more than one “right” way to do most
things.
Please help me with social interactions. It may look like I don’t want to play with the
other kids on the playground, but sometimes it’s just that I simply do not know how
to start a conversation or enter a play situation. If you can encourage other children to
invite me to join them at kickball or shooting baskets, it may be that I’m delighted to be
included. I do best in structured play activities that have a clear beginning and end. I
don’t know how to “read” facial expressions, body language or the emotions of others, so
I appreciate ongoing coaching in proper social responses. For example, if I laugh when
Emily falls off the slide, it’s not that I think it’s funny. It’s that I don’t know the proper
response. Teach me to say “Are you OK?”
Try to identify what triggers my meltdowns. Meltdowns, blow-ups, tantrums, or

whatever you want to call them, are even more horrid for me than they are for you.
They occur because one or more of my senses has gone into overload. If you can figure
out why my meltdowns occur, they can be prevented. Keep a log, noting times, settings,
people, activities. A pattern may emerge. Try to remember that all behavior is a form of
communication. It tells you, when my words cannot, how I perceive something that is
happening in my environment. Parents, keep in mind as well: persistent behavior may
have an underlying medical cause. Food allergies and sensitivities, sleep disorders, and
gastrointestinal problems can all have profound effects on behavior.
Love me unconditionally. Banish thoughts like, “If he would just ” and “Why can’t
she ..” You did not fulfill every last expectation your parents had for you and you
wouldn’t like being constantly reminded of it. I did not choose to have autism. But
remember that it is happening to me, not you. Without your support, my chances of
successful, self-reliant adulthood are slim. With your support and guidance, the
possibilities are broader than you might think. I promise you – I am worth it.
And finally, three words: Patience. Patience. Patience. Work to view my autism as a
different ability rather than a disability. Look past what you may see as limitations and
see the gifts autism has given me. It may be true that I’m not good at eye contact or
conversation, but have you noticed that I don’t lie, cheat at games, tattle on my
classmates or pass judgment on other people? Also true that I probably won’t be the
next Michael Jordan. But with my attention to fine detail and capacity for extraordinary
focus, I might be the next Einstein. Or Mozart. Or Van Gogh. They had autism too. The
answer to Alzheimer’s, the enigma of extraterrestrial life -- what future achievements
from today’s children with autism, children like me, lie ahead? All that I might become
won’t happen without you as my foundation. Be my advocate, be my friend, and we’ll
see just how far I can go.
#
oeJJf#[//*"#@5$-5%,#
#
#
54
8&44*.*"$#S55('#0":#G*-'&$*'#Z*'5"0$*#;&$%#8&44*.*"$#
X0,&/&*'C#O*.*#0.*#'5,*#$%0$#90.*"$'#%07*#.*=5,,*":*:C#X5.#
0#,5.*#=5,9/*$*#/&'$#54#-55('#0":#;*-#'&$*')#0'#;*//#0'#
,0>0W&"*')#9.5:+=$')#0":#8^8')#9/*0'*#7&'&$#5+.#Z*'5+.=*#
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By Veronica Zysk and Ellen Notbohm#(Publisher: Future Horizons; 1 edition, 2004)#
2#60.*"$]'#d+&:*#$5#2'9*.>*.#<B":.5,*#i#O&>%?X+"=$&5"&">#2+$&',##
By Sally Ozonoff, Ph.D., Geraldine Dawson, Ph.D., James McPartland (Publisher: The
Guildford Press; 1 edition, 2002)
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House; 1 edition, 1999)
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By Karen Siff Exkorn (Publisher: Collins; 1 edition, 2006)
2+$&',#<9*=$.+,#8&'5.:*.'T#F%*#D5,9/*$*#d+&:*
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By Brian Jepson, M.D. and Jane Johnson (Publisher: Sentient Publications; 1 edition
2007)
D%&/:.*"#;&$%#2+$&',T#2#60.*"$]'#d+&:*##
By Michael D. Powers (Publisher: Woodbine House; 2 Sub edition, 2000)
D5+/:#&$#-*#2+$&',H#2#60.*"$]'#d+&:*#$5#$%*#X&.'$#<&>"'#0":#@*P$#<$*9'#
By Nancy Wiseman (Publisher: Broadway; 1 edition, 2006)
85*'#,B#D%&/:#O07*#2+$&',H#2#60.*"$]'#d+&:*#$5#[0./B#8*$*=$&5"#0":#
!"$*.7*"$&5"#&"#2+$&',#<9*=$.+,#8&'5.:*.'#
By Wendy L. Stone, Ph.D. and Theresa Foy Digeronimo, MED(Publisher: Jossey-Bass;
1 edition, 2006)
55
X0=&">#2+$&',T#d&7&">#60.*"$'#Z*0'5"'#45.#O59*#0":#d+&:0"=*#45.#O*/9##
By Lynn M. Hamilton (Publisher: WaterBrook Press; 1 edition, 2000)
Y*$#M*#O*0.#b5+.#^5&=*##
By Catherine Maurice (Publisher: Ballantine Books, 1994)
Y55(#M*#&"#$%*#[B*T#MB#Y&4*#;&$%#2'9*.>*.p'#
By John Elder Robinson (Three Rivers Press, 2008)
M0(&">#6*0=*#;&$%#2+$&',T#A"*#X0,&/Bp'#<$5.B#54#<$.+>>/*)#8&'=57*.B)#0":#
E"*P9*=$*:#d&4$'#
By Susan Senator (Trumpeter, 2006)
@5$#MB#S5BkT#2#X0$%*.)#2#<5")#0":#A"*#X0,&/Bp'#a5+."*B#;&$%#2+$&',##
By Rodney Peete (Hyperion 2010)
@5+.&'%&">#O59*##
by Julie Matthews (www.NourishingHope.com)
A7*.=5,&">#2+$&',T#X&":&">#$%*#2"';*.')#<$.0$*>&*')#0":#O59*#F%0$#D0"#
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By Lynn Kern Koegel, PhD Claire LaZebnik (Publisher: Penguin /Non-Classics, 2005)
6/0B&">)#Y0+>%&">)#0":#Y*0."&">#;&$%#D%&/:.*"#5"#$%*#2+$&',#<9*=$.+,T#2#
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By Julia Moor (Publisher: Jessica Kingsley Publishers; 1 edition, 2002)
6/0B#0":#*">0>*,*"$#&"#*0./B#0+$&',T#F%*#[0./B#<$0.$#8*"7*.#M5:*/""
by Sally Rogers, PhD and Geraldine Dawson, PhD. Publisher: New York: Guilford
Publishing, 2009)
2#6.0=$&=0/#d+&:*#$5#2+$&',T#G%0$#[7*.B#60.*"$)#X0,&/B#M*,-*.)#0":#F*0=%*.#
@**:'#$5#h"5;##
By Fred R. Volkmar and Lisa A. Wiesner (Wiley, 2009)
<&-/&">'#54#D%&/:.*"#;&$%#2+$&',T#2#d+&:*#45.#X0,&/&*'#
By Sandra L. Harris, PhD and Beth A. Glasberg, Ph.D. (Publisher: Woodbine House,
1994)
<9*=&0/#8&*$'#45.#<9*=&0/#6*59/*T#E":*.'$0":&">#0":#!,9/*,*"$&">#0#d/+$*"?
X.**#0":#D0'&*"?X.**#8&*$#$5#2&:#&"#$%*#F.*0$,*"$#54#2+$&',#0":#Z*/0$*:#
8*7*/59,*"$0/#8&'5.:*.'##
By Lisa S. Lewis (Publisher: Future Horizons, 2005)
56
<$.0">*#<5"#
By Portia Iverson (Riverhead Trade, 2007)
F*"#F%&">'#[7*.B#D%&/:#;&$%#2+$&',#G&'%*'#b5+##
By Ellen Notbohm (Future Horizons, 2005)
F%*#D5,9/*$*#d+&:*#$5#2'9*.>*.]'#<B":.5,*#
By Tony Attwood (Jessica Kingsley Publishers, 2008)
#
F%*.*p'#0#S5B#&"#O*.*##
By Judy Barron and Sean Barron (Future Horizons, 2002)
F%&"(&">#&"#6&=$+.*')#[P90":*:#[:&$&5"T#MB#Y&4*#;&$%#2+$&',##
By Temple Grandin (Vintage, 2006)
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b5+p.*#d5&">#$5#Y57*#F%&'#h&:kT#F*0=%&">#<$+:*"$'#G&$%#2+$&',#&"#$%*#!"=/+'&7*#
D/0''.55,##
By Paula Kluth (Brookes Publishing Company, 2003)
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[7*.B-5:B#&'#8&44*.*"$T#2#S55(#45.#b5+">#6*59/*#;%5#%07*#S.5$%*.'#5.#<&'$*.'#
;&$%#2+$&',
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Company, 2002)
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By Ellen Sabin (Reading Level: Ages 9-12, Publisher: Watering Can
38 Press; 1 edition, 2006)
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www.Autism.com
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57
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www.UnlockingAutism.org
58
A Week by Contacts
100 Days Action Plan

A section for service providers, caregivers and others
Week Plan Schedules

A section for therapy times, program start and end
dates, deadlines
for the Diagnosis
Next 100
A section for medical documents and any prescrip-
tions
Therapy
Days
A section for Speech, Occupational Therapy, SI, and
so on (Multiple or sub sections may be necessary)
Individual Family Service Plan

(IFSP)
Getting
A section for your child’s IFSP and related docu-
ments (For children under three years of age)
Organized Individualized Education Plan

(IEP) A section for your child’s IEP and related
documents (For children older than three years)
The first thing you will need to do
is get yourself organized. You may already find
you’ve accumulated a lot of paperwork about your
We’ve included a sample contact list,

child and about autism in general. Organizing the
information and records that you collect for your
child is an important part of managing his or her phone log and weekly planner in this kit so you can copy
care and progress. If you set up a simple system, and use them as needed. You may also want to summarize
things will be much easier over time. You may your child’s progress in therapy and at school with cover
need to stop by an office supply store to pick up a sheets in each section; sample summary sheets are also in
binder, dividers, some spiral notebooks, loose leaf the Resources Section.
paper or legal pads and pens.
Using your Weekly Planner

The time frame and action items will vary depend-
The Binders ing on your child’s symptoms, your child’s age, where you
live and what you have already accomplished.
Many parents find that binders Even if you are very on top of this, it may take a
are a great tool for keeping the mountains of while to be able to access additional evaluations and the
paperwork down to a more manageable, mole hill services that your child needs.
size and for sharing information. You may want to
Start now.
organize by subject or by year. In either case, here
are some of the subjects that you are likely to want
to have at your fingertips:
Week 1 Week 2
Complete Evaluations Getting Support
If your child has not had a complete work up, Find a support group or a parent mentor. If your child is
schedule the remainder of necessary evaluations in school, you may also want to find out if your district
(see Getting Services below). has a Special Education Parent Teacher Association
(SEPTA), which may offer informational meetings and
parent outreach.
Getting Services
If your child is younger than three, you’ll start with
Early Intervention (EI) often through your state Getting Services (Follow Up)
department of health. If your child is three or older, Follow up on services. Continue to check status on
you’ll start with your local school district. Call to waiting lists and available programs.
begin the process of getting services. EI or your
school district may want to conduct evaluations
of your child (at their expense). This can be a long Research Treatment Options
and time consuming process, but may be useful in Start to read material, join online groups and ask
further determining the services that are needed. questions that will help you understand the treatment
options that are available and what might be right for
your child and your family.
Keep a Phone Log
Try to set aside some time each day to make the
phone calls necessary to set up the evaluations
and to start the process of getting services. There
may be a waiting list for services and evaluations,
so make the calls as soon as possible and follow
up as needed—and don’t hesitate to put your
name on multiple lists so you can get the earliest
appointment possible. Some of the professionals
who provide services through Early Intervention or
Week 3
Special Education may take a specified number of
days to complete evaluations or begin services.
Start a Video Record

Try a variety of settings and show a range of behavior.
Note both good and not-so-good behavior so that,
Getting Services (Continue to
in the future, you will be able to recognize where Follow Up)
your child was at that point in time. Make a new Follow up on services. Continue to check status on
recording every three months at home, in therapy waiting lists and available programs. Keep using your
sessions, wherever. These video “snapshots” can be phone log to record the dates you contacted service
used to track your child’s progress and help show providers and track when you may need make another
what effect a particular therapy or intervention may call.
have had. Label the tapes or discs with your child’s
name and the dates they were recorded.
Play with Your Child
Play with your child. Play is an important part of any
child’s development, and is a critical part of learning
socialization for a child with autism. We’ve included
a very helpful article, Ideas for Purposeful Play, from
the University of Washington’s Autism Center that
illustrates how to include useful play activities, which
will help your child learn.
Set Aside Sibling Time
The siblings of children with autism are affected by
the disorder as well. Consider spending time talking
together about their feelings. Start a “Joy Museum”
Week 5
together of happy memories. Talking about these Continue Building Your Team
times can help them remember that their lives involve See Week 4.
a lot more than autism.
Review Your Insurance
Investigate your insurance coverage to see what
if any therapies are covered and make sure that
you are getting the most from your provider. Your
health insurance may cover therapies or services not
covered by your child’s IFSP or IEP. You may need to
create a separate binder to keep track of insurance
claims. Document everything.
Week 4 Get to know Your Child’s

Legal Rights
Familiarize yourself with your child’s rights. There is
Build Your Team a wealth of information available. You may find out
By this time, your child’s team of therapists, educators your child is entitled to services you weren’t aware
and caregivers is probably taking shape. Continue to of or hadn’t considered.
look for service providers and observe as many therapy
sessions as possible to identify new recruits for your
child’s team. Talk to other parents who may know Do Something for You
of therapists with time available for your child. You You’ve made it through a month, and it may have
don’t have to wait until every member of the team is been one of the most challenging months of your
in place before beginning therapy. life. Remember to take care of yourself. Remember
who you were before the diagnosis. Spend some
time on an activity that you enjoy. You will find it
Create a safety plan helps you face the challenges ahead. There are
You may already have had to adapt your home because probably friends and family in your life who would
of your child’s behaviors or needs. You’ve probably love to help, but may not know what you need.
already read the section of this kit called Create a Don’t be afraid to ask for help.
Safety Plan. If not, carve out some time to survey your
home for possible problems and begin contacting
local safety personnel to plan ahead to ensure your
child’s safety.
Plan some Time Away

Plan some time away from your child. You will do
a better job helping your family if you take care of
yourself. Even if it’s just going for a walk alone, you
are going to need a break so that you can come back
with a clear head.
Week 6 Week 7
Continue to Research Become Competent in the
Treatment Options Intervention Methods you have
Continue to research treatment options. If possible,
go to a workshop or look for additional information Chosen for Your Child
online. Take advantage of parent training. Therapists often
provide parent training that will help bring the meth-
Connect with Other Parents ods used at therapy into your home and help your
Go to a support group or spend some time with a child’s progress.
parent who can help you along your journey. You’ll
learn a lot and being around people who know what
you are going through will help you stay strong. Create a Schedule
Having a written weekly schedule for your child’s
therapy schedule will help you see if you’ve scheduled
Find Childcare your time well. It will also help you plan for the other
Get a baby-sitter. Look into qualified baby-sitting members of your household.
services and respite care. Don’t wait until you’re
desperate—find someone you’re comfortable with
and plan a night out. If you already have a great Continue Learning about
baby-sitter, invite her or him to spend some time Treatments & Services
with you and your child so they can adjust to the Continue research on treatments and services. Con-
new techniques your family is using at home. sult the Autism Speaks web site for contacts in your
area.
Build your Team
Continue to follow up on services and research any Spend some time organizing
new possible providers.
your paperwork
Organize any paperwork that may have piled up. Try
Schedule a Team Meeting to eliminate any materials you won’t need.
If you’ve built a team of therapists, you may want
to call a meeting to establish procedures and goals
and open lines of communication. You’ll also want
to continue observing therapy sessions and using
what you learn at home. If it’s difficult to schedule a
time for the service providers to meet in person, you
may want to schedule a conference call instead.
Week 8
Check your Progress
Look back through this action item list. Is there
anything you started that needs follow up?
Investigate Recreational Continue to Connect with
Activities for Your Child Other Parents
Add a recreational activity, such as gymnastics or Stay active with a support group or, if possible,
swimming, to broaden your child’s development. socialize with other parents of children with Autism.
Being around other adults who understand what
your family is going through will help you stay
Plan more Sibling Time strong.
Your typically-developing children will no doubt
be richer for having a sibling with Autism. But
maintaining as much normalcy as possible will help Check in on Your Child’s
them reach their potential too.
Sessions
Continue to observe therapy. Your child should be
Make Contact with Friends and getting used to their therapy routine at this point.
Family
Stay connected. Make contact with your friends and Play with Your Child
family and participate in community events. Keeping Play with your child. Continue to use the strategies
up your social life will help you safeguard against you’ve learned from parent training sessions and
feelings of isolation. other resources.
Spend Time Alone with Your

Spouse
Plan a relaxing and fun activity with your partner.
After all, you’ve just made it through month two.
Week 10
Schedule a Team Meeting
It’s team meeting time again. Schedule a meeting
to discuss progress and strategies. Stay involved
Week 9
with your team by continuing to attend as many
sessions as possible.
Rally the Troops

Round out Your Team Encourage your team. Let them know you appreciate
everything they are doing for your child.
Continue to evaluate service providers and therapists.
Use the Internet Plan a Family Outing

Plan a family outing. Schedule an activity designed
Get e-savvy. Spend time researching online resources
to include your child with autism and utilize
that will keep you up-to-date. Add useful Web sites
strategies you’ve picked up from therapy. Ask your
to your favorites, register for e-newsletters and join
child’s therapist to help you with specific strategies
list-servs where parents and professionals share
to make the outing a success.
information.
Brush up on the Law Continue Connecting with
Continue to learn about your child’s legal rights.
Other Parents
Keep going to support groups. Parents are amazing
resources and will help provide emotional and
practical support. Look into additional groups in
your area if you don’t feel you’ve found the right
one for you.
Sign up for More Training

Using the methods you are learning from your
Week 11
child’s therapists will help create a productive en-
vironment at home, so your child will have the best
chance of obtaining their goals.
Check Your Child’s Progress

Look for progress. Hopefully, your child has been
through a consistent month of therapy at this point.
Review your binder and videos to see if you notice
improvements. Continue to attend sessions too.
Week 13
Take notes on what you see. Keep a copy in your
binder and bring them to your next team meeting.
Dig deeper into Treatment

Options Hold a Team Meeting
Set aside time to do some research and reading on Check on progress again. You should continue to
additional treatments and therapies. Make notes see progress after at least six weeks of consistent
and copy useful information to include in your therapy. If there has been little or no progress, call
binder. another team meeting to brainstorm and make
adjustments to your child’s routine.
Continue Learning
Keep learning about autism. Books, seminars, movies,
Web sites—all sorts of sources can help you deepen
your understanding of autism and your child. See
the Suggested Reading List in this kit for ideas.
Do Something for You
Week 12
Enjoy some “me” time. Do something nice for your-
self—you’ve made it through 100 days!
Reconnect with Your Spouse

Take some one-on-one time to enjoy each other’s
company. If communication has been difficult,
consider scheduling time with a counselor to keep
your relationship healthy.
Ideas for Purposeful Play
From the University of Washington Autism Center Parent Care Book
Imitation: Object and Motor

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Receptive and Expressive Labeling

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Are You Prepared
for an Autism
Autism Safety Kit

How can I Emergency?
A leading cause of concern
keep my child for parents with a child with autism
Safe?
is children who run or wander away. In a recent online
survey conducted by NAA, an incredible 92% of the
parents who responded reported their children were
Autism presents a unique set at risk of wandering. This is a problem that must
be addressed in every city and town across America.
of safety concerns for parents. The advocacy
Please review the following information and contact
your local first responders to get a plan in place for
and awareness groups, Unlocking Autism (UA) and the
your child and others who may be at risk in your
National Autism Association (NAA), have teamed up to
provide the following safety information for parents. Not community.
all suggestions listed below are right for every family in Wandering can occur anywhere at anytime.
every neighborhood. You should carefully consider the The first time is often the worst time. Another
best safety options for your individual child. concern is preparation in the event that you become
{ }
incapacitated or injured while caring for a person
with autism at home or in the community. If you are
“We had no idea Louis concerned that your child may wander, now is the time
was out of the house, when to get to know your local law enforcement, fire and
we received a call from a ambulance agencies. Ask your local 911 call center to
“red flag” this information in their 911 computer data
neighbor. Thankfully, they
base. Should you need help in the future, dispatchers
were familiar with Lou and can alert patrol officers about your concerns before
knew how to reach us.” they arrive. By providing law enforcement with key
information before an incident occurs, you can expect
better responses.
{ }
Make sure any alterations
you make to your home not
delay or prevent fire, police,
ambulance or rescue personnel
from getting to her or him
immediately in an emergency.
An ounce of
prevention…
You know the expression, Create an
“an ounce of prevention is worth a
pound of cure.” Following are some tools and ideas
to help you plan for and prevent emergencies.
informational
Survey and secure your home
Are there changes you can make to help ensure
handout about
your child’s safety? If wandering is an issue for your
family, consider contacting a professional locksmith,
security company or home improvement professional
your child.
to prepare your home. You may find it is necessary to
prevent your child from slipping away unnoticed by:
Having a description of
t*OTUBMMJOHTFDVSFEFBECPMUMPDLTUIBUSFRVJSF and information about your child could be an
keys on both sides. incredibly valuable tool in ensuring his or her safety.
t*OTUBMMJOHBIPNFTFDVSJUZBMBSNTZTUFN It should be copied and carried with you at all times,
t*OTUBMMJOHJOFYQFOTJWFCBUUFSZPQFSBUFEBMBSNT at home, in your car, purse or wallet. Include a photo
on doors and windows to alert you when they of your child and any important information. Be sure
are opened. These are available at stores like to include your name, address and phone number.
WalMart and Radio Shack. Circulate this handout to family members, trusted
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your child’s reach. will also come in handy if you are in an area other
t'FODJOHZPVSZBSE than your neighborhood and need the help of or
are approached by the police. This is one item it is
important to have before you actually need it.
Alert your
neighbors
The behaviors and characteristics
of a child with autism have the potential to attract
attention from the public. Law enforcement
professionals suggest that you reach out and get to
know your neighbors.
Decide what information to present to neighbors:
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or is he drawn to them?
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stranger think he is deaf?
Plan a brief visit to your neighbors:
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t*GBOFJHICPSTQPUTZPVSDIJMEPVUTJEFPGZPVS
yard, what is the best way for them to get your tracking device.
child back to you? Some use a small unit that is put in a child’s pocket
t"SFUIFSFTFOTPSZJTTVFTZPVSOFJHICPST or backpack and work with your computer or mobile
should know about? phone so that you can monitor your child’s location.
Others involve a handheld unit for the parent which
Give your neighbor a simple handout with your name, tracks the location of the child’s wristband. Some
address, and phone number. Ask them to call you units work with local law enforcement and rescue
immediately if they see your child outside the home. personnel. The tracking distance for the devices
This approach may be a good way to avoid problems varies considerably and ranges from 300 feet for
down the road and will let your neighbors: parent monitored units to one mile on the ground
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t,OPXUIBUZPVBSFBQQSPBDIBCMF rescue personnel. Some systems include waterproof
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they call 911 TPNFQBSFOUNPOJUPSJOHVOJUTUPBSPVOE GPS
,OPXJOH ZPVS OFJHICPST BOE NBLJOH UIFN units tied into local rescue personnel. Many local
comfortable with your child’s differences can lead to law enforcement agencies have purchased units
better social interactions for your child. for tracking residents with autism, Alzheimer’s and
Down’s Syndrome.
Teach your child

to swim.
Too often, children with
autism are often attracted to water sources such
as pools, ponds, and lakes. Drowning is a leading
cause of death for a child or adult who has Autism.
Be sure your child knows how to swim unassisted.
Swimming lessons for children with special needs
are available at many YMCA locations. The final
lesson should be with clothes on.
Consider a Medical ID
Bracelet for your child.
You may want to purchase an ID Bracelet for your
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your name and telephone number. State that your
DIJMEIBTBVUJTNBOEJTOPOWFSCBMJGBQQMJDBCMF
If your child will not wear a bracelet or necklace,

consider a temporary tattoo with your contact
information.
Child with Autism
le
Emergency Information
p
sa m Child may:
Sean likes to climb and may often be found playing on
climbing equipment at playgrounds or climbing trees or
fences. Sean flaps his arms up and down and rocks from
foot to foot when he is excited or afraid.
Favorite places:
South Marlboro Elementary School Playground
Marlboro Haven Mall – Water Fountain
Photo taken: 11/1/2007
May be frightened by:
Sean O’Donnell Sean is very afraid of dogs and may hide to avoid them
or scream and run away. He is very sensitive to loud
Physical Description noises.
l e
Date of Birth: 6/21/2002 Best way to communicate:
p
Sean has a limited vocabulary but can understand “Let’s
Height: 3’ 6” go see Mom” or “Let’s go home.” He will respond if
m
asked his name. He can give yes or no answers but may
a
Weight: 54 lbs.
s
answer yes or no without understanding the question.
Eye Color: brown Identification:

Sean wears a MED ID bracelet for EPILEPSY
Hair Color: brown
Scars: small scar above right eyebrow

Contact Immediately:
Name Peggy O’Donnell
Home phone 508-555-7238
Identifying Marks: birthmark on left shoulder blade
Mobile phone 508-550-7239
e
Relationship Mother
Responds to:
p l
Sean loves SpongeBob Square Pants. He may be carrying Name Robert O’Donnell
a stuffed Sponge Bob toy. He loves to hear about Sponge Home Phone 508-555-7238
m
Bob and the Sponge Bob song. He will answer yes or no Mobile phone 508-550-7240
a
questions about Sponge Bob characters like Squidward and Relationship Father
s
Patrick from the Sponge Bob Show
Home Address: 463 Canterbury Way
Please be aware that: South Marlboro, MA
Sean currently takes medication for seizures. Check MED 01000
ID bracelet. He does not like to have his head touched. He
will tolerate being taken by the hand. PLEASE REFER TO ATTACHED MAP FOR
LOCATION OF PLAYGROUNDS AND HOME.
Comparing Treatment Methods & Providers
Adapted from: Does My Child Have Autism? By Wendy L. Stone, Ph.D. with Theresa Foy DiGeronimo
PROGRAM
Comparing Treatment Methods

Name of Program/Provider
Method
Location
Phone Number
Email
Website
Hours per Week

Cost
Reimbursement
Recommended by
PROGRAM CONTENT
Areas of development
focused on:
(language, communication, toy
play, imitation, peer play, social
interactions, behavior, pre-academic
skills, work skills, parent training)
How specific goals are identified

for each child:
How behaviors and skills are

prioritized:
What kind of teaching is used:
How behaviors are managed:
MEASURING PROGRESS
How will I know if my child is

making progress?
How long will it be before I see

changes?
What types of improvements

should I expect?
How often will you assess

progress & how is it measured?
What will happen if my child
doesn’t make progress with this
treatment?
THERAPIST QUALIFICATIONS
How many children with Autism

have you worked with?
What ages?
Do you serve children over three

years old?
What are your qualifications?

What type of training do you
have?
Do you have a professional

degree or certificate
(Ask for details)
Are you affiliated with a

professional organization?
(Ask for details)
What do you see as your

strongest skills in working with
children with Autism?
Are there issues or problems you

consider to be outside of your
realm of expertise?
SCIENTIFIC EVIDENCE OF EFFECTIVENESS

Is there research to support the
effectiveness of this type of
treatment?
(Ask for details as well as copies
of published articles)
Has research shown this

treatment to be better than
other types of treatment?
PROFESSIONAL INVOLVEMENT
Who will be providing the direct

intervention with my child?
What type of training do they

have?
Who will be supervising them

and how?
How often will you see my child

personally?
PARENT INVOLVEMENT
Will I be able to participate in the
treatment?
Will you teach me to work with

my child? How?
What skills will you teach me?

(Ask for examples)
COMPATIBLITY WITH OTHER TREATMENTS

How many hours per week of
your treatment will my child
need?
Is your treatment compatible

with other interventions my
child is participating in?
How do you collaborate with

other therapy providers on my
child’s team?
(get examples)
Service Provider Planner
Requested #
Date
Agency & Contact Phone # Requested Services of Sessions & Availability Status Follow-Up Other Info
Called
Duration
Kid’s Agency 4 sessions - 30 Jane Smith - 2 Will call me back Jane’s #555-2222
555-555-555 1/7/08 Speech Can Start 2/1/08
Mary Jones min each sessions can start 1/15/08 email: jane@speechteherpay.com
Requested #
Date
Agency & Contact Phone # Requested Services of Sessions & Availability Status Follow-Up Other Info
Called
Duration
Kid’s Agency 4 sessions - 30 Jane Smith - 2 Will call me back Jane’s #555-2222
555-555-555 1/7/08 Speech Can Start 2/1/08 email: jane@speechtherapy.com
Mary Jones min each sessions can start 1/15/08
CONTACTS - Medical
Contacts
Specialty Neurology Specialty
Name of Contact Dr. Sample Doctor Name of Contact
Name of Practice Children’s Hospital Name of Practice
Phone Number (508)555-1000 Phone Number
Address
2000 Summit Drive Address
Anytown, MA 01000
Email Address/ Email Address/

Website Sample.doctor@childrens.edu Website
Specialty Specialty
Name of Contact Name of Contact
Name of Practice Name of Practice
Phone Number Phone Number
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
CONTACTS - Therapy
Address
2000 Summit Drive
Address
Anytown, MA 01000

Specialty Specialty

Address Address

Website Website
Specialty Specialty
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
CONTACTS - Support
Address
2000 Summit Drive Address
Anytown, MA 01000

Specialty Specialty
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
CONTACTS - Other
Specialty Specialty
Address Address

Website Website
Specialty Specialty

Address Address

Website Website
Specialty Specialty
Address Address

Website Website
Specialty Specialty
Address Address

Website Website
Phone Log
Name of Contact
Phone Log
Phone Number
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Phone Log
Name of Contact
Phone Number
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Date/Time
Summary of Call
Follow up Required
Type of Therapy:
Change in
Assessment Tracking
Change in Age
Date Test Administered Evaluator Standard Score Age Equivalent Standard
Equivalent
Score
Oral & Written Language Scales Ms. Smith

1/12/07 (Subtest) Oral Expression 49 3.4
(Subtest) Listening Comprehension 48 3.5
Oral & Written Language Scales Ms. Jones
2/8/08 (Subtest) Oral Expression 50 3.8 1 4 months
(Subtest) Listening Comprehension 57 4.1 9 8 months
Team Meeting/Review 10 2 1
Type of Therapy:
Change in
Change in Age
Date Test Administered Evaluator Standard Score Age Equivalent Standard
Equivalent
Score
IFSP / IEP Goals
Goal Tracking
Goals
Goals Goals Just Goals Not
Date Comments Making
Mastered Started Started
Progress
Sept. 06 Started Program 0 0 10 6
Nov. 06 Team Meeting/Review 2 10 3 3
Jan. 06 Team Meeting/Review 4 10 2 1

Goals
Goals Goals Just Goals Not
Date Comments Making
Mastered Started Started
Progress
Glossary
Asperger’s Disorder, PDD – Not Otherwise Specified,
Childhood Disintegrative Disorder, and Retts Disorder.
Glossary
Visit the Autism Speaks Video Glossary at
www.AutismSpeaks.org to see video of the items in blue.
C
A Casein is protein found in milk, used in forming the basis of
cheese and as a food additive.
Absence Seizure, see Seizures
Americans with Disabilities Act (ADA) is the US law Celiac Disease is a disease in which there is an immuno-
that ensures rights of persons with disabilities with logical reaction within the inner lining of the small intestine
regard to employment and other issues. to gluten, causing inflammation that destroys the lining and
reduces the absorption of dietary nutrients. It can lead to
Angelman Syndrome is a genetic disorder causing symptoms of nutritional, vitamin and mineral deficiencies.
developmental delay and neurological problems,
often accompanied by seizures. Children often Cerebral Palsy (CP) is an abnormality of motor function (as
display hyperactivity, small head size, sleep disorders opposed to mental function) that is acquired at an early
and movement and balance disorders. age, usually in utero or at less than a year of age, and is due
to a brain lesion that is non-progressive.
Anticonvulsant is a type of drug used to prevent or
stop seizures or convulsions. Also called antiepileptic. Childhood Disintegrative Disorder is a disorder in which
development begins normally in all areas, physical and
Aphasia is the complete or partial loss of ability to use mental. At some point between 2 and 10 years of age, the
or understand language. child loses previously developed skills. The child may lose
social and language skills and other functions, including
Apraxia is a disorder consisting of partial or total bowel and bladder control.
incapacity to execute purposeful movements, without
impairment of muscular power and coordination. The Chromosome15 Duplication Syndrome is a rare chromosomal
person has difficulty sequencing movements. Apraxia disorder. Symptoms may be similar to Prader-Willi and
may be specific to speech. Angelman syndromes and range from asymptomatic
cases to variable combinations of skeletal, neurological,
Applied Behavior Analysis (ABA) is a style of teaching gastrointestinal, psychological, and other abnormalities in
using series of trials to shape desired behavior or association with developmental delay.
response. Skills are broken into small components and
taught to child through a system of reinforcement. Chronic Constipation is an ongoing condition of having
fewer than three bowel movements per week.
Asperger Syndrome is a developmental disorder
on the Autism spectrum defined by impairments Clinical Features are directly observed during examination;
in communication and social development and by based on or characterized by observable and diagnosable
repetitive interests and behaviors, without a significant symptoms of disease.
delay in language and cognitive development.
Cognition is mental process of knowing, including aspects
Astatic Seizure, see Seizures such as awareness, perception, reasoning and judgment.
Atonic Seizure, see Seizures Cognitive Skills are any mental skills that are used in
the process of acquiring knowledge; these skills include
Audiologist is a professional who diagnoses and treats, reasoning, perception and judgment.
individuals with hearing loss or balance problems.
Colitis is inflammation of the large intestine .
Autism Diagnostic Observation Schedule (ADOS) is test
considered to be current gold standard for diagnosing Complete Blood Count (CBC) lab test reporting number of
ASD and, along with information from parents, should white blood cells, red blood cells, platelets, hemoglobin,
be incorporated into a child’s evaluation. hematocrit & other values reflecting overall blood health.
Autism Spectrum Disorders encompasses the Compulsions are deliberate repetitive behaviors that follow
following disorders listed in DSM-IV: Autistic Disorder, specific rules, such as pertaining to cleaning, checking, or
counting. In young children, restricted patterns of either immediately after hearing word or phrase, or
interest may be early sign of compulsions. much later. Delayed echolalia occurs days or weeks
later. Functional echolalia is using quoted phrase in
Computed Axial Tomography (CT) examines organs by a way that has shared meaning, for example, saying
scanning with X rays and using computer to construct “carry you” to ask to be carried.
series of cross-sectional scans. Called “CAT” scan.
Electroencephalogram (EEG) a test using electrodes on
Cytomegalovirus (CMV) common virus of herpes family. scalp to record electrical brain activity. For diagnoses
May be asymptomatic in healthy people. May be serious of seizure disorder or abnormal brain wave patterns.
in patient with impaired immune system. Infection in
utero may cause serious developmental disorders. Epilepsy (Seizure disorder) is pattern of repeated
seizures, causes include head injury, brain tumor,
D lead poisoning, genetic & infectious illnesses. Cause
Declarative Language is used to communicate what is unknown in 50% of cases.
the mind is producing. It is what is most common in
conversation, whereas Imperative Language is used to Esophagitis is inflammation of the esophagus,
ask questions, make commands or give instructions. the soft tube-like portion of the digestive tract
connecting the pharynx with the stomach.
Developmental Disorder refers to several disorders that
affect normal development. May affect single area Expressive Labeling is the communication of a name
of development (specific developmental disorders) or for an object or person, see expressive language.
several (pervasive developmental disorders).
Expressive Language is communication of intentions,
Developmental Individual Difference Relationship (DIR) desires, or ideas to others, through speech or printed
is therapy, known as Floortime, that seeks to move the words. Includes gestures, signing, communication
child toward increasingly complex interactions through board and other forms of expression.
mutually shared engagement.
Extended School Year (ESY) Services are provided
Developmental Milestones skills or behaviors that during lbreaks from school, such as during summer
most children can do by a certain age that enable the vacation, for students who experience substantial
monitoring of learning, behavior, and development. regression in skills during school vacations.
Developmental Pediatrician is a medical doctor who F

is board-accredited and has received sub-specialty Free Appropriate Public Education (FAPE) means that
training in developmental-behavioral pediatrics. education must be provided to all children ages three
to twenty-one at public expense.
Diagnostic and Statistical Manual the official system for
classification of psychological and psychiatric disorders Floortime a developmental intervention for children
published by the American Psychiatric Association. with autism involving meeting a child at his current
developmental level, and building upon a particular
Discrete Trial Teaching (DTT), is technique incorporating set of strengths.
principles of ABA, including positive reinforcement. Not
in itself ABA. Used to teach behaviors in one-to-one Fragile X is a genetic disorder that shares many of
setting. Concepts are broken down into small parts. the characteristics of autism. Individuals may be
tested for Fragile X.
Dyspraxia is brain’s inability to plan muscle movements
and carry them out. In Speech, this term may be used
to describe Apraxia.
G
Gastritis is inflammation of the stomach.
E Gastroenterologist doctor specializing in diagnosis

Early Intervention (EI) is a state-funded program & treatment of disorders of Gl tract, including
designed to identify and treat developmental problems esophagus, stomach, small intestine, large intestine,
or other disabilities as early as possible. Eligibility for EI pancreas, liver, gallbladder & biliary system.
is from birth to three years of age.
Gastroesophageal Reflux return of stomach contents
Echolalia is repeating words or phrases heard previously, back up into the esophagus which frequently causes
heartburn due to irritation of the esophagus by in all areas; family’s resources, priorities, & concerns,
stomach acid. services to be received and the frequency, intensity,
and method of delivery. Must state natural
Gastrointestinal pertains to the digestive tract, environments in which services will occur.
including the mouth, throat, esophagus, stomach,
small intestine, large intestine, and rectum. Individualized Education Plan (IEP) identifies
student’s specific learning expectations, how school
General Education is a pattern of courses in multiple will address them with appropriate services, and
subjects taught to the same grade level to deliver a methods to review progress. For students 14 & older,
well-balanced education. must contain plan to transition to postsecondary
education or the workplace, or to help the student
Geneticist refers to a medical doctor who specializes live as independently as possible in the community.
in genetic problems. Genes are the unit in the
chromosome that contain the blueprint for the Individuals with Disabilities Education Act (IDEA) is the
transmission of inherited characteristics. US law mandating the “Free and Public Education” of
all persons with disabilities between ages 3 and 21.
Gestures are hand and head movements, used to signal
to someone else, such as a give, reach, wave, point, Infectious agents are organisms that cause infection;
or head shake. They convey information or express can be viruses, bacteria, fungi, or parasites.
emotions without the use of words.
Inclusion involves educating all children in regular
Global Developmental Delay is diagnosis in children classrooms, regardless of degree or severity of
younger than 5, characterized by delay in two or more disability. Effective inclusion takes place with
developmental domains, sometimes associated with planned system of training and supports; involves
mental retardation. collaboration of multidisciplinary team including
regular and special educators.
Gluten is a protein present in wheat, rye, and barley.
Grand mal Seizure, see Seizures J

Joint Attention is the process of sharing one’s
H experience of observing an object or event, by
following gaze or pointing gestures. Critical for
Hyperlexia is the ability to read at an early age. To be
social development, language acquisition, cognitive
hyperlexic, a child does not need to understand what
development. Impairment in joint attention is a core
he or she is reading.
deficit of ASD.
Hyperresponsiveness, Hypersensitivity, see Sensory
Defensiveness K
Hyposensitivity, Hyporesponsiveness, is abnormal L
insensitivity to sensory input. Child who appears to be Least Restrictive Environment (LRE) is setting that least
deaf, whose hearing is normal, is under reactive. Child restricts opportunities for child with disabilities to be
who is under reactive to sensory input may have a high with peers without disabilities. The law mandates
tolerance to pain, may be clumsy, sensation-seeking, that every child with a disability be educated in a
and may act aggressively. Least Restrictive Environment.
Hypotonia is a term that means low muscle tone.

M
I Magnetic Resonance Imaging (MRI) is a diagnostic
technique using powerful electromagnets, radio
Incidental Teaching teaches a child new skills while in frequency waves, and a computer to produce well-
their home or community, in natural context or “in the defined images of the body’s internal structures.
moment,” to help make sense of what they learn dur-
ing formal instruction and generalize new skills. Mainstreaming is where students are expected to
participate in existing regular ed classes, whereas
Individual Family Service Plan (IFSP) is developed by a in an inclusive program classes are designed for
multidisciplinary team including family as primary all students. May be gradual, partial, or part-time
participant. Describes child’s level of developmentl process (e.g., student may attend separate classes
within regular school, or participate in regular gym efforts to breathe continue. Throat collapses during
and lunch only). sleep causing snorting and gasping for breath. May
cause daytime sleepiness. May increase risk of
Maternal Rubella is a mild, highly contagious virus, hypertension and heart problems.
also known as “German measles” that crosses the
placenta from infected mothers and leads to major Occupational Therapy assists development of fine
developmental defects in developing fetus. motor skills that aid in daily living. May focus on
sensory issues, coordination of movement, balance,
Melatonin is a hormone produced by pineal gland, and self-help skills such as dressing, eating with a fork,
involved in regulating sleeping and waking cycles. grooming, etc. May address visual perception and
Sometimes used for chronic insomnia. Consult your hand-eye coordination.
child’s physician before giving melatonin; it is not
recommended for all patients with sleep problems. Occupational Therapist helps minimize impact of
disability on independence in daily living by adapting
Mental Retardation describes person with limitations child’s environment and teaching sub-skills of the
in mental functioning that cause them to develop missing developmental components.
more slowly than typical child. They may take longer
to learn to speak, walk, and take care of personal Operant Conditioning is the modification of behavior
needs such as dressing or eating, and are likely to have through positive and/or negative reinforcement.
trouble learning in school. May be mild or severe.
P
Modified Checklist of Autism in Toddlers (MCHAT) is Perseveration is repetitive movement or speech, or
a screening tool for identifying young children who sticking to one idea or task, that has a compulsive
may be referred to specialist for further evaluation quality to it.
and possible Autism Spectrum Disorder diagnosis.
Pervasive Developmental Disorders (PDD) group of
Motor deficits are physical skills that a person cannot conditions involving delays in development of many
perform or has difficulty performing. basic skills, including ability to socialize with others, to
communicate and use imagination. Includes Autism,
Motor function (or Motor Skills) is the ability to move
Asperger Syndrome, Childhood Disintegrative Disorder,
and control movements.
Rett Syndrome and Pervasive Development Disorder -
N Not Otherwise Specified.
Neurocutaneous Disorders are genetic disorders Pervasive Developmental Disorder – Not Otherwise
leading to abnormal growth of tumors. Usually Specified (PDD-NOS) a category of PDD referring
first appearing as skin lesions like birthmarks; may to children having significant problems with
eventually lead to tumors affecting central nervous communication & play, and some difficulty interacting
system and other parts of the body. with others, but are too social for diagnosis of autism.
Neurologist refers to a doctor specializing in medical Petit Mal Seizure, see Seizures
problems associated with the nervous system,
specifically the brain and spinal cord. Phenylketonuria (PKU) a metabolic disorder involving
deficiency of enzyme phenylalanine hydroxylase
Nonverbal Behaviors are things people do to convey which leads to harmful buildup of phenylaline in body.
information or express emotions without words, Symptoms range from mild to severe. May cause
including eye gaze, facial expressions, body postures, mental retardation.
and gestures.
Physical Therapy uses specially designed exercises and
O equipment to help patients regain or improve their
Obsessions are persistent and intrusive repetitive physical abilities.
thoughts. Preoccupations with specific kinds of ob-
jects or actions may be an early sign of obsessions. Physical Therapists design and implement physical
therapy programs and may work within a hospital or
Obstructive Sleep Apnea breathing disorder clinic, in a school, or as an independent practitioner.
interrupting breathing during sleep when air flow
cannot flow through the nose or mouth although Pica is persistent eating or mouthing of non nutritive
substances for at least 1 month when behavior is begins to understand words and responds to his
developmentally inappropriate (older than 18-24 name and may respond to familiar words in context.
months). Substances may includeitems such as clay, By 18 to 20 months a child identifies familiar people
dirt, sand, stones, pebbles, hair, feces, lead, laundry by looking when named (e.g., Where’s mommy?),
starch, vinyl gloves, plastic, erasers, ice, fingernails, gives familiar objects when named (e.g., Where’s the
paper, paint chips, coal, chalk, wood, plaster, light ball?), and points to a few body parts (e.g., Where’s
bulbs, needles, string, cigarette butts, wire, and burnt your nose?). These skills commonly emerge slightly
matches. ahead of expressive language skills.
Picture Exchange Communication System (PECS) an Reinforcement, or reinforcer, is any object or event
alternative communication system using picture following a response, increasing or maintaining
symbols. Taught in phases starting with simple the rate of responding. Positive reinforcer may be
exchange of symbol for desired item. Individuals learn produced by, or be added after a response.
to use picture symbols to construct complete sentences,
initiate communication, & answer questions. Relationship Development Intervention (RDI) a
therapeutic teaching method based on building
Pivotal Response Treatment (PRT) therapeutic teaching intelligence competencies of social connection --
method using incidental teaching opportunities such as referencing, emotion sharing, coregulation,
to target and modify key behaviors related to and experience sharing -- that normally develop in
communication, behavior, and social skills. infancy and early childhood.
Prevalence is the current number of people in a given Respite Care is temporary, short-term care provided
population who have a specific diagnosis at a specified to individuals with disabilities, delivered in the home
point in time. for a few short hours or in an alternate licensed
setting for an extended period of time. Respite care
Proprioception is the receiving of stimuli originating in allows caregivers to take a break in order to relieve
muscles, tendons and other internal tissues. and prevent stress and fatigue.
Prosody is the rhythm and melody of spoken language Rett Syndrome is a very rare disorder in which
expressed through rate, pitch, stress, inflection, or patient has symptoms associated with PDD along
intonation. Some children with ASD have unusual with problems with physical development. They
intonation (flat, monotonous, stiff, or “sing songy” generally lose many motor, or movement, skills –
without emphasis on the important words). such as walking and use of hands – and develop poor
coordination. Condition has been linked to defect on
Psychiatrist is a doctor specializing in prevention, the X chromosome, so it almost always affects girls.
diagnosis & treatment of mental illness. Has received
additional training & completed a supervised residency
in specialty. May have additional training in specialty,
S
Seizure refers to uncontrolled electrical activity in
such as child psychiatry or neuropsychiatry. Can
the brain, which may produce a physical convulsion,
prescribe medication, which psychologists cannot do.
minor physical signs, thought disturbances, or a
Psychologist is a professional who diagnoses and combination of symptoms.
treats diseases of the brain, emotional disturbance,
Seizure, Absence, takes form of staring spell. Person
and behavior problems. May have a master’s degree
suddenly seems “absent.” Has brief loss of awareness.
(M.A.) or doctorate (Ph.D.) in psychology. May have
May be accompanied by blinking or mouth twitching.
other qualifications, including Board Certification and
Absence seizures have very characteristic appearance
additional training in a specific type of therapy.
on EEG. Also called a petit mal seizure.
Q Seizure, Atonic, seizure where person loses muscle
tone & strength &, unless supported, falls down.
R Atonic means lack of muscle tone & strength.
Receptive Labeling, see receptive language
Seizure, Subclinical (Electrographic Seizures), are sei-
Receptive Language the ability to comprehend words zures that are visible on the EEG, but the patient does
and sentences. Begins as early as birth and increases not exhibit clinical symptoms. Electroencephalogra-
with each stage in development. By 12 months a child phy often detects subclinical seizures during sleep.
Seizure, Tonic-clonic, Seizures involving two phases – ample, a social story might be written about birthday
tonic phase when body becomes rigid, & clonic phase parties if the child appears to have a difficult time
of uncontrolled jerking. May be preceded by aura & understanding what is expected of him or how he is
are often followed by headache, confusion, & sleep. supposed to behave at a birthday party.
May last for seconds, or continue for several minutes.
Social Worker is a trained specialist in the social,
Self Regulation and self-control are related but not the emotional & financial needs of families & patients.
same. Self-regulation refers to both conscious and Social workers often help families & patients obtain
unconscious processes that have an impact on self- the services they have been prescribed.
control, but regulatory activities take place more or less
constantly to allow us to participate in society, work, & Special Education is specially designed instruction,
family life. Self-control is a conscious activity. at no cost to families, to meet unique needs of child
with disability, including instruction conducted in the
Sensory Defensiveness is a tendency, outside the norm, classroom, in the home, in hospitals & institutions, &
to react negatively or with alarm to sensory input in other settings & instruction in physical education.
which is generally considered harmless or non-irritat-
ing to others. Also called hypersensitivity. Speech & Language Therapist, or Speech Language
Pathologist, specializes in human communication.
Sensory Input, see sensory stimuli The focus is on communication, not speech, to
increase child’s ability to impact and understand their
Sensory Integration is the way the brain processes environment.
sensory stimulation or sensation from the body &
then translates that information into specific, planned, Speech & Language Therapy is provided with the goal
coordinated motor activity. of improving an individual’s ability to communicate.
This includes verbal and nonverbal communication.
Sensory Integration Dysfunction a neurological disorder The treatment is specific to the individual’s need.
causing difficulties processing information from the
five classic senses (vision, hearing, touch, smell, & taste), Spoken Language (also referred to as expressive
sense of movement (vestibular system), and positional and receptive language) use of verbal behavior, or
sense (proprioception). Sensory information is sensed speech, to communicate thoughts, ideas, & feelings
normally, but perceived abnormally. May be a disorder with others. Involves learning many levels of rules -
on its own, or with other neurological conditions. combining sounds to make words, using conventional
meanings of words, combining words into sentences,
Sensory Integration Therapy is used to improve ability and using words & sentences in following rules of
to use incoming sensory information appropriately & conversation.
encourage tolerance of a variety of sensory inputs.
Stereotyped Behaviors refer to an abnormal or
Sensory stimulus agent, action or condition, internal excessive repetition of an action carried out in
(e.g., heart rate, temperature) or external (e.g., sights, the same way over time. May include repetitive
sounds, tastes, smells, touch, & balance) that elicits movements or posturing of the body or objects.
physiological or psychological response. Response
depends on ability to regulate & understand stimuli & Stereotyped Patterns of Interest or restricted patterns
adjust emotions to demands of surroundings. of interest refer to a pattern of preoccupation with a
narrow range of interests and activities.
Sleep Hygiene a set of practices, habits & environmental
factors critically important for sound sleep, such as Stim, or “self-stimulation” behaviors that stimulate
minimizing noise, light & temperature extremes & ones senses. Some “stims” may serve a regulatory
avoiding naps & caffeine. function (calming, increasing concentration, or
shutting out an overwhelming sound).
Social Reciprocity back-and-forth flow of social
interaction. How behavior of one person influences & Subclinical Seizure, see Seizures
is influenced by behavior of another & vice versa.
Symbolic Play is where children pretend to do things &
Social Stories, developed by Carol Gray, are simple sto- to be something or someone else. Typically develops
ries that describe social events & situations that are between the ages of 2 & 3 years. Also called make
difficult for a child with a PDD to understand. For ex- believe, or pretend play.
Syndrome is a set of signs & symptoms that collectively
define or characterize a disease, disorder or condition. X
T Y
Tactile Defensiveness is a strong negative response to a
sensation that would not ordinarily be upsetting, such Z
as touching something sticky or gooey or the feeling of www.AutismSpeaks.org
soft foods in the mouth. Specific to touch.
Thalidomide is a sedative & hypnotic drug that has

been the cause of malformation of infants born to
mothers using it during pregnancy. Thalidomide acts
as an angiogenesis inhibitor & can inhibit bone forma-
tion. Currently used to treat certain types of cancer.
Training and Education of Autistic and Related

Communication Handicapped Children (TEACCH) is
a therapeutic approach broadly based on the idea
that individuals with autism more effectively use &
understand visual cues.
Tonic-clonic seizure, see Seizures
Tuberous Sclerosis is a neurocutaneous disorder

characterized by mental retardation, seizures, skin
lesions & intracranial lesions. An autosomal dominant
disorder that occurs in 1 in 7,000 births.
Typical Development (or healthy development)

describes physical, mental, & social development of
a child who is acquiring or achieving skills according
to expected time frame. Child developing in a healthy
way pays attention to voices, faces, & actions of others,
showing & sharing pleasure during interactions,
& engaging in verbal & nonverbal back-and-forth
communication.
U
V
Valproate, or Valproic Acid, is an antiepileptic drug
used to treat epilepsy, migraines & bipolar disorder.
Given orally or by injection. Associated with high rate
of serious adverse events, including major congenital
abnormalities & fetal death with in utero exposure.
Verbal Behavior is a method of Applied Behavioral

Analysis (ABA) for teaching children with autism,
based on B.F. Skinner’s description of the system of
language.
Vestibular System refers to the body’s system for

maintaining equilibrium.
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Autism Speaks maintains the Family Services Resource Guide as a service to families
as a reference tool. Every effort is made to ensure listings are up-to-date. Autism
Speaks does not endorse or claim to have personal knowledge of the abilities of those
listed. The resources listed in these pages are not intended as a recommendation,
referral, or endorsement of any resource or as a tool for verifying the credentials,
qualifications, or abilities of any organization, product or professional. Users are urged to
use independent judgment and request references when considering any resource
associated with diagnosis or treatment of autism, or the provision of services related to
autism.

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Call us at 888-AUTISM 2 (288-4762) or email familyservices@autismspeaks.org.

Consider keeping a journal. Louise DeSalvo, in Writing as a Way of Healing, notes

The participation of children with disabilities in the general education environment is

Examples of these treatments are Speech & Language Therapy, Occupational

! An antecedent, which is a verbal or physical stimulus such as a command or

PRT is used to teach language, decrease disruptive/self-stimulatory behaviors, and

! Emotional Referencing: The ability to use an emotional feedback system to learn

The program involves a systematic approach to working on building motivation and

Specific Things to Look for on the Resume:#

My sensory perceptions are disordered. Sensory integration may be the most

Try to identify what triggers my meltdowns. Meltdowns, blow-ups, tantrums, or

100 Days Action Plan

Week Plan Schedules

for the Diagnosis

Individual Family Service Plan

Organized Individualized Education Plan

We’ve included a sample contact list,

Using your Weekly Planner

Start a Video Record

Week 4 Get to know Your Child’s

Plan some Time Away

Spend Time Alone with Your

Rally the Troops

Use the Internet Plan a Family Outing

Sign up for More Training

Check Your Child’s Progress

Dig deeper into Treatment

Do Something for You

Reconnect with Your Spouse

Imitation: Object and Motor

Receptive and Expressive Labeling

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Autism Safety Kit

Teach your child

If your child will not wear a bracelet or necklace,

Eye Color: brown Identification:

Scars: small scar above right eyebrow

Comparing Treatment Methods

Hours per Week

How specific goals are identified

How behaviors and skills are

What kind of teaching is used:

How behaviors are managed:

How will I know if my child is

How long will it be before I see

What types of improvements

How often will you assess

How many children with Autism

Do you serve children over three

What are your qualifications?

Do you have a professional

Are you affiliated with a

What do you see as your

Are there issues or problems you

SCIENTIFIC EVIDENCE OF EFFECTIVENESS

Has research shown this

Who will be providing the direct

What type of training do they

Who will be supervising them

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